Provider Demographics
NPI:1033613856
Name:OTTE, CHELSEA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:OTTE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1228
Mailing Address - Country:US
Mailing Address - Phone:973-459-2180
Mailing Address - Fax:
Practice Address - Street 1:535 HIGH MOUNTAIN RD STE 104
Practice Address - Street 2:
Practice Address - City:NORTH HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-2652
Practice Address - Country:US
Practice Address - Phone:973-423-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002299002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000025992OtherBOC AT CERTIFICATION
NJ25MT00229900OtherSTATE OF NJ BOARD OF MEDICAL EXAMINERS