Provider Demographics
NPI:1043376056
Name:OTTO, MARGARET (LSCSW,LCSW,)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:LSCSW,LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 NE 83RD ST STE 2350
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-4467
Mailing Address - Country:US
Mailing Address - Phone:816-436-1721
Mailing Address - Fax:816-436-1180
Practice Address - Street 1:3100 NE 83RD ST STE 2350
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-4467
Practice Address - Country:US
Practice Address - Phone:816-436-1721
Practice Address - Fax:816-436-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0002751041C0700X
KS7121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOR22106Medicare UPIN
MO0002180AMedicare ID - Type Unspecified