Provider Demographics
NPI:1013067834
Name:OTLIN, JO-ANN (MA,CCC)
Entity Type:Individual
Prefix:MS
First Name:JO-ANN
Middle Name:
Last Name:OTLIN
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SALVIA DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1840
Mailing Address - Country:US
Mailing Address - Phone:508-473-4670
Mailing Address - Fax:
Practice Address - Street 1:345 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1723
Practice Address - Country:US
Practice Address - Phone:508-473-3422
Practice Address - Fax:508-473-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist