Provider Demographics
NPI:1952128225
Name:OTTEN, ELIZABETH DIANE (LAC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANE
Last Name:OTTEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 CEDAR CT
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-9599
Mailing Address - Country:US
Mailing Address - Phone:360-224-4179
Mailing Address - Fax:
Practice Address - Street 1:1405 FRASER ST STE F-101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5886
Practice Address - Country:US
Practice Address - Phone:360-224-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61605847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist