MEDICARE: MS. RHONDA B OTWAY MFT

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	106H00000X	Marriage & Family Therapist	MFC 42530	CA
2	106H00000X	Marriage & Family Therapist	202178	TX
3	101YP2500X	Professional Counselor	LPCC542	CA

General Provider Information

NPI Number	:	1831213255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA B OTWAY MFT

Provider Business Mailing Address
First Line	:	24165 W IH 10 # 217-620
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1159
Country	:	US
Telephone Number	:	830-302-8540
Fax Number	:	925-901-0234

Provider Business Practice Location Address
First Line	:	8000 FAIR OAKS PKWY
Second Line	:	SUITE 204
City	:	FAIR OAKS RANCH
State	:	TX
Zip	:	78015-4739
Country	:	US
Telephone Number	:	830-302-8540
Fax Number	:	925-901-0234

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	01/24/2015

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