Individual
SUSAN OTT STAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 CAMPO RD, TIJERAS, NM 87059-7615
(208) 818-4774
Mailing address
25 CAMPO RD, TIJERAS, NM 87059-7615
(208) 818-4774
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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