Individual
PHILLIP MARTIN OTTERNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3152 23RD AVE S APT 2, MINNEAPOLIS, MN 55407-5573
(612) 321-8008
Mailing address
3152 23RD AVE S APT 2, MINNEAPOLIS, MN 55407-5573
(612) 321-8008
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
10/26/2023
Last updated
10/26/2023
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