Provider Demographics
NPI:1740399773
Name:OTT, PEGGY JEAN (PH D)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:JEAN
Last Name:OTT
Suffix:
Gender:F
Credentials:PH D
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Mailing Address - Street 1:4716 ELLSWORTH AVE
Mailing Address - Street 2:STE 102 CATHEDRAL MANSIONS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-621-9979
Mailing Address - Fax:412-621-9573
Practice Address - Street 1:4716 ELLSWORTH AVE
Practice Address - Street 2:STE 102 CATHEDRAL MANSIONS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-621-9979
Practice Address - Fax:412-621-9573
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS004922L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
597989OtherHIGHMARK BLUE CROSS BLUE
R07495Medicare UPIN
597989OtherHIGHMARK BLUE CROSS BLUE