Provider Demographics
NPI:1356927933
Name:OTAZO, SARAH LOUISE (FNTP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:LOUISE
Last Name:OTAZO
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2213
Mailing Address - Country:US
Mailing Address - Phone:973-943-9037
Mailing Address - Fax:
Practice Address - Street 1:88 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2213
Practice Address - Country:US
Practice Address - Phone:973-943-9037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2531133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist