Individual
MATTHEW NICHOLAS OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
TCADC
Contact information
Practice address
600 PERIMETER DR STE 125, LEXINGTON, KY 40517-4296
(866) 678-8123
Mailing address
761 DAWSON SPRINGS WAY, LEXINGTON, KY 40511-2315
(928) 830-9476
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
290511
KY
Other
Enumeration date
12/17/2020
Last updated
06/24/2024
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