Individual
JAQUI OTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1664 KELLER PARKWAY STE 102, KELLER, TX 76248
(817) 492-5105
Mailing address
1664 KELLER PARKWAY STE 102, KELLER, TX 76248
(817) 492-5105
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
32976
TX
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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