Provider Demographics
NPI:1700370798
Name:OTT, JULIA
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
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 1:100 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-1135
Mailing Address - Country:US
Mailing Address - Phone:215-280-0336
Mailing Address - Fax:
Practice Address - Street 1:730 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1326
Practice Address - Country:US
Practice Address - Phone:856-617-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00553900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional