Provider Demographics
NPI:1316578909
Name:OTTO, DARLA (CSW, MSM, CTACC)
Entity Type:Individual
Prefix:MS
First Name:DARLA
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:CSW, MSM, CTACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 CEDAR LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-4053
Mailing Address - Country:US
Mailing Address - Phone:920-889-5369
Mailing Address - Fax:
Practice Address - Street 1:13333 CEDAR LAKE RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-4053
Practice Address - Country:US
Practice Address - Phone:920-894-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, ChildGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child