Individual
TARA MARIE OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
220 FLIVA AVE NW, FORT WALTON BEACH, FL 32548
(952) 595-1100
(612) 294-4903
Mailing address
11995 SINGLETREE LN, STE 500, EDEN PRAIRIE, MN 55344-5347
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
036133782
IL
2085R0202X
Diagnostic Radiology Physician
2021040905
MO
2085R0202X
Diagnostic Radiology Physician
Primary
ME113202
FL
Other
Enumeration date
05/29/2008
Last updated
04/14/2025
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