Individual
TIA MICHELLE OTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SFA
Contact information
Practice address
12502 WILLOWBROOK RD STE 500, CUMBERLAND, MD 21502-6572
(301) 722-8847
Mailing address
12405 BUTLER DR NW, LAVALE, MD 21502-6027
(301) 876-5440
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
209275
MD
Other
Enumeration date
08/29/2023
Last updated
08/29/2023
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