Individual
MRS. DIANE MARIE OTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC SLP
Contact information
Practice address
265 S NATIONAL AVE, FOND DU LAC, WI 54935-5334
(920) 922-7342
(920) 922-4737
Mailing address
824 SHADY RIDGE CT, GRAFTON, WI 53024-9534
(262) 377-6056
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
780-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42655300
—
WI
Enumeration date
05/01/2007
Last updated
10/01/2008
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