Provider Demographics
NPI:1407932718
Name:OTTO, PAUL STEARNS (PH D)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEARNS
Last Name:OTTO
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4240
Mailing Address - Country:US
Mailing Address - Phone:707-468-8348
Mailing Address - Fax:707-462-5881
Practice Address - Street 1:205 W CLAY ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5452
Practice Address - Country:US
Practice Address - Phone:707-462-1644
Practice Address - Fax:707-462-5881
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9139103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00 PL 91390Medicare ID - Type Unspecified