Provider Demographics
NPI:1710209747
Name:OTTO, LE TU (LAC)
Entity Type:Individual
Prefix:
First Name:LE
Middle Name:TU
Last Name:OTTO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COURT A
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5227
Mailing Address - Country:US
Mailing Address - Phone:626-377-2822
Mailing Address - Fax:
Practice Address - Street 1:711 COURT A
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-5227
Practice Address - Country:US
Practice Address - Phone:626-377-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60313649171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist