Provider Demographics
NPI:1639513625
Name:OTTERSON, LILIAN EDEN (LMT)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:EDEN
Last Name:OTTERSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GREAT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1999
Mailing Address - Country:US
Mailing Address - Phone:617-571-0692
Mailing Address - Fax:
Practice Address - Street 1:311 GREAT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-1999
Practice Address - Country:US
Practice Address - Phone:617-571-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist