Provider Demographics
NPI:1336368117
Name:OTT, DAWN ARLEEN (RN)
Entity Type:Individual
Prefix:MR
First Name:DAWN
Middle Name:ARLEEN
Last Name:OTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 TRYSTY FRIEND PL
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1822
Mailing Address - Country:US
Mailing Address - Phone:410-551-6347
Mailing Address - Fax:
Practice Address - Street 1:1103 26TH ST
Practice Address - Street 2:
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-1251
Practice Address - Country:US
Practice Address - Phone:410-674-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR078890163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool