Provider Demographics
NPI:1205452000
Name:OTTINGER, DARBY ALISON
Entity type:Individual
Prefix:
First Name:DARBY
Middle Name:ALISON
Last Name:OTTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 E SICILY DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5263
Mailing Address - Country:US
Mailing Address - Phone:208-573-5349
Mailing Address - Fax:
Practice Address - Street 1:12553 W EXPLORER DR STE 190
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1612
Practice Address - Country:US
Practice Address - Phone:208-972-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician