MEDICARE: BARBARA A OTTENHOFF PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY202688	ID

General Provider Information

NPI Number	:	1750396537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA A OTTENHOFF PSYD

Provider Business Mailing Address
First Line	:	2965 E TARPON DR
Second Line	:	SUITE 150
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9009
Country	:	US
Telephone Number	:	208-906-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2965 E TARPON DR
Second Line	:	SUITE 150
City	:	MERIDIAN
State	:	ID
Zip	:	83642-9009
Country	:	US
Telephone Number	:	208-906-6740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/12/2013

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