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Individual

JOHN A OTALLAH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ED. S.

Contact information

Practice address
14115 LOVERS LN, SUITE 56, CULPEPER, VA 22701-4157
(540) 308-3857
Mailing address
17158 LAKEMONT DR, CULPEPER, VA 22701-7910
(540) 825-1462

Taxonomy

Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
0803000022
VA

Other

Enumeration date
08/23/2011
Last updated
08/23/2011
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