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Individual

MRS. KIMBERLY M OTTER

Active
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Individual

MRS. KIMBERLY M OTTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD LDN

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2004029302
MO
133V00000X
Registered Dietitian
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000009329891
PRIVATE HEALTHCARE SYSTEM
IL
01
00132009
BLUE CROSS BLUE SHIELD
IL
01
075113
QUINCY HEALTH CARE MGMT.
IL
Enumeration date
08/12/2005
Last updated
07/13/2026
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