Provider Demographics
NPI:1760411466
Name:OTT, GAIL (DC)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:OTT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 NW PETTYGROVE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2659
Mailing Address - Country:US
Mailing Address - Phone:503-224-4804
Mailing Address - Fax:503-224-7391
Practice Address - Street 1:2230 NW PETTYGROVE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2659
Practice Address - Country:US
Practice Address - Phone:503-224-4804
Practice Address - Fax:503-224-7391
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor