Provider Demographics
NPI:1629486121
Name:OTTER, BILLIE JEAN (OT)
Entity Type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:JEAN
Last Name:OTTER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:BILLIE
Other - Middle Name:JEAN
Other - Last Name:BENTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22443 SE 240TH ST
Mailing Address - Street 2:STE 206
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5898
Mailing Address - Country:US
Mailing Address - Phone:425-358-3070
Mailing Address - Fax:
Practice Address - Street 1:22443 SE 240TH ST
Practice Address - Street 2:STE 206
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5898
Practice Address - Country:US
Practice Address - Phone:425-358-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60408508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist