Provider Demographics
NPI:1205183589
Name:OTT, MARTINE SUSKO (CRNP)
Entity Type:Individual
Prefix:DR
First Name:MARTINE
Middle Name:SUSKO
Last Name:OTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
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Mailing Address - Street 1:807 LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1549
Mailing Address - Country:US
Mailing Address - Phone:215-257-6551
Mailing Address - Fax:215-257-9347
Practice Address - Street 1:1288 VALLEY FORGE ROAD
Practice Address - Street 2:UNIT 54
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460
Practice Address - Country:US
Practice Address - Phone:267-563-8180
Practice Address - Fax:484-848-5195
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP012228363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health