Individual
JILL VAN OTTERLOO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
635 E US HIGHWAY 9, FOREST CITY, IA 50436-1028
(641) 585-2904
(641) 585-5417
Mailing address
621 S ILLINOIS AVE, SUITE 103, MASON CITY, IA 50401-5489
(641) 428-3041
(641) 428-3059
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
074615
IA
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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