Provider Demographics
NPI:1205375516
Name:OTTEN, DEBORAH ANN (LSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:OTTEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NORTH HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MT. ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154
Mailing Address - Country:US
Mailing Address - Phone:937-444-6127
Mailing Address - Fax:937-444-6192
Practice Address - Street 1:116 NORTH HIGH STREET
Practice Address - Street 2:
Practice Address - City:MT. ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154
Practice Address - Country:US
Practice Address - Phone:937-444-6127
Practice Address - Fax:937-444-6192
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1000044104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker