Provider Demographics
NPI:1295102952
Name:OTT, JOSHUA GREGORY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GREGORY
Last Name:OTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1734
Mailing Address - Country:US
Mailing Address - Phone:541-296-5452
Mailing Address - Fax:541-296-2731
Practice Address - Street 1:207 W 3RD ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1734
Practice Address - Country:US
Practice Address - Phone:541-296-5452
Practice Address - Fax:541-296-2731
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator