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Individual

MR. IAN SETH OTTO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
13400 SUTTON PARK DR S, SUITE 1101, JACKSONVILLE, FL 32224-0236
(904) 254-8713
Mailing address
13525 VALBUENA CT, JACKSONVILLE, FL 32224-3087
(904) 536-4962

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
26-4600206
FL

Other

Enumeration date
07/25/2009
Last updated
07/25/2009
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