Provider Demographics
NPI:1295030997
Name:OTTOLINI, KATHLEEN HEATHER (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:HEATHER
Last Name:OTTOLINI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:HEATHER
Other - Last Name:HECHST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1813 WESTMEADE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4676
Mailing Address - Country:US
Mailing Address - Phone:314-707-0086
Mailing Address - Fax:
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-707-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010031371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor