Provider Demographics
NPI:1740565902
Name:OTT, DEBORAH KAY (MS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:OTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 74 BOX 48-3
Mailing Address - Street 2:
Mailing Address - City:HARTSHORNE
Mailing Address - State:OK
Mailing Address - Zip Code:74547-9705
Mailing Address - Country:US
Mailing Address - Phone:918-448-2888
Mailing Address - Fax:918-297-3701
Practice Address - Street 1:310 S 10TH ST
Practice Address - Street 2:
Practice Address - City:HARTSHORNE
Practice Address - State:OK
Practice Address - Zip Code:74547-4212
Practice Address - Country:US
Practice Address - Phone:918-297-3700
Practice Address - Fax:918-297-3701
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor