MEDICARE: JODI OTTO

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	235Z00000X	Speech-Language Pathologist	SP-6170	OH

General Provider Information

NPI Number	:	1962808204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI OTTO

Provider Business Mailing Address
First Line	:	1123 SOM CENTER RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2006
Country	:	US
Telephone Number	:	440-995-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 IROQUOIS AVE
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-1547
Country	:	US
Telephone Number	:	440-995-7828
Fax Number	:

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

Provider Enumeration Date	:	11/14/2014
Last Update Date	:	11/14/2014

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Directions to “ JODI OTTO ” Practice Location

Language	Start Address	Practice Location

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