Individual
MR. MICHAEL E OTTO
Active
Individual
MR. MICHAEL E OTTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT186
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010020633
GCPT REGENCE OF ID
ID
05
—
002682600
—
ID
01
—
T1385
GCPT BLUE CROSS OF ID
ID
Enumeration date
04/10/2006
Last updated
03/08/2013
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