Provider Demographics
NPI:1043507742
Name:OTTE, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:OTTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:DAVID CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68632-0211
Mailing Address - Country:US
Mailing Address - Phone:402-367-1250
Mailing Address - Fax:
Practice Address - Street 1:640 W 6TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:NE
Practice Address - Zip Code:68649-4430
Practice Address - Country:US
Practice Address - Phone:402-367-7970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist