Individual
MR. TRAVIS LEWELLEN OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
2505 CROWDER LN, TAMPA, FL 33629-6253
(813) 361-4809
Mailing address
6225 WILLET CT, LAKEWOOD RANCH, FL 34202-8224
(813) 361-4809
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8595
FL
Other
Enumeration date
09/18/2012
Last updated
09/16/2014
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