Individual
JACQUELINE PAULINE OTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2984 SHAFOR BLVD, KETTERING, OH 45419-1632
(740) 506-2163
Mailing address
2984 SHAFOR BLVD, KETTERING, OH 45419-1632
(740) 506-2163
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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