Provider Demographics
NPI:1982760039
Name:OTTINGER, HOLLY DIANN (DPH)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:DIANN
Last Name:OTTINGER
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 N HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1414
Mailing Address - Country:US
Mailing Address - Phone:580-255-3784
Mailing Address - Fax:580-252-6278
Practice Address - Street 1:1842 N HIGHWAY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1414
Practice Address - Country:US
Practice Address - Phone:580-255-3784
Practice Address - Fax:580-252-6278
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist