Individual
HEIDI SUZANNE OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
147 TRIPLE CT, VINE GROVE, KY 40175-8610
(270) 547-0199
Mailing address
147 TRIPLE CT, VINE GROVE, KY 40175-8610
(270) 547-0199
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-437721
KY
Other
Enumeration date
06/03/2025
Last updated
06/03/2025
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