Individual
MS. DIANA L OTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
33650 6TH AVE S, FEDERAL WAY, WA 98003-6754
(209) 740-6827
Mailing address
33650 6TH AVE S, FEDERAL WAY, WA 98003-6754
(209) 740-6827
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60179290
WA
Other
Enumeration date
11/19/2010
Last updated
11/19/2010
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