MEDICARE: KRISTA OTT

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	183500000X	Pharmacist	56971	TX

General Provider Information

NPI Number	:	1871960146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA OTT

Provider Business Mailing Address
First Line	:	1632 MARTIN LUTHER KING JR BLVD STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3209
Country	:	US
Telephone Number	:	972-817-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1632 MARTIN LUTHER KING JR BLVD STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215-3209
Country	:	US
Telephone Number	:	972-817-6000
Fax Number	:

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	06/02/2026

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Directions to “ KRISTA OTT ” Practice Location

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