Provider Demographics
NPI:1730638651
Name:OTT, STEPHANIE (PA)
Entity Type:Individual
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First Name:STEPHANIE
Middle Name:
Last Name:OTT
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Gender:F
Credentials:PA
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Mailing Address - Street 1:65 SPRINGFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1895
Mailing Address - Country:US
Mailing Address - Phone:413-562-8306
Mailing Address - Fax:413-568-5678
Practice Address - Street 1:65 SPRINGFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1895
Practice Address - Country:US
Practice Address - Phone:413-562-8306
Practice Address - Fax:413-568-5678
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2023-05-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant