Provider Demographics
NPI:1235691791
Name:OTTINGER, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:OTTINGER
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 1:10933 JOANN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-6431
Mailing Address - Country:US
Mailing Address - Phone:903-277-4495
Mailing Address - Fax:
Practice Address - Street 1:10933 JOANN ST
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-6431
Practice Address - Country:US
Practice Address - Phone:903-277-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2145026225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant