Individual
KYLE JONATHAN OTTENBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
9414 RIDGETOP BLVD NW STE 106, SILVERDALE, WA 98383-8526
(360) 286-2647
(360) 286-2652
Mailing address
1200 CORPORATE DR STE 400, BIRMINGHAM, AL 35242-5424
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/27/2017
Last updated
12/11/2018
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