Individual
MS. MICHELLE RENEE OTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
17 E HIGH ST, LEBANON, PA 17042-5455
(717) 270-6101
Mailing address
17 E HIGH ST, LEBANON, PA 17042-5455
(717) 270-6101
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
TE000663L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TE000663L
LICENSE
PA
Enumeration date
06/12/2007
Last updated
07/08/2007
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