Provider Demographics
NPI:1861865008
Name:OTTO, NEIL
Entity Type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:OTTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEIL
Other - Middle Name:
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT-0484
Mailing Address - Street 1:307 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3101
Mailing Address - Country:US
Mailing Address - Phone:307-332-2715
Mailing Address - Fax:307-332-0314
Practice Address - Street 1:307 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3101
Practice Address - Country:US
Practice Address - Phone:307-332-2715
Practice Address - Fax:307-332-0314
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-0484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist