Provider Demographics
NPI:1215400486
Name:OTTO, JAIME ANNE
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ANNE
Last Name:OTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32650 STATE ROUTE 20 STE 108
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2641
Mailing Address - Country:US
Mailing Address - Phone:360-279-9000
Mailing Address - Fax:
Practice Address - Street 1:32650 STATE ROUTE 20 STE 108
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2641
Practice Address - Country:US
Practice Address - Phone:360-279-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60912906106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician