Provider Information for 1710358916
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Mrs. JESSICA MARIE OTTON LCSW
Sex: Female
NPI: 1710358916
Last Updated: 2015-10-13
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1710358916 | ||||||||
| Enumeration Date | 2015-10-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1431 NW 15TH TER CAPE CORAL, FL 33993-5034 United States Phone: 239-628-7855 | Fax: | ||||||||
| Primary Practice Address | 17861 OAKMONT RIDGE CIR FORT MYERS, FL 33967-7202 United States Phone: 239-628-7855 | Fax: | ||||||||
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