Provider Demographics
NPI:1295138220
Name:OTTO, MADALYN (ND)
Entity type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 N STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4300
Mailing Address - Country:US
Mailing Address - Phone:603-369-4626
Mailing Address - Fax:
Practice Address - Street 1:91 N STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4300
Practice Address - Country:US
Practice Address - Phone:603-369-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-05
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH115175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath