Provider Demographics
NPI:1497363378
Name:OTT, SANDRA KAY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:OTT
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 1:120 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-3020
Mailing Address - Country:US
Mailing Address - Phone:304-991-5141
Mailing Address - Fax:
Practice Address - Street 1:120 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-3020
Practice Address - Country:US
Practice Address - Phone:304-991-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide