Provider Demographics
NPI:1497907299
Name:OTTEN, KATRINA LYNNE (RD)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:LYNNE
Last Name:OTTEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SIERRA ST APT S
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2308
Mailing Address - Country:US
Mailing Address - Phone:760-873-8851
Mailing Address - Fax:760-873-6362
Practice Address - Street 1:52 N TU SU LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8058
Practice Address - Country:US
Practice Address - Phone:760-873-8851
Practice Address - Fax:760-873-6362
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA916884133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered