Provider Demographics
NPI:1033943246
Name:OTT, ALLISON SUZANNE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:SUZANNE
Last Name:OTT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 3RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1322
Mailing Address - Country:US
Mailing Address - Phone:319-929-9447
Mailing Address - Fax:
Practice Address - Street 1:287 SE WESTOWN PARKWAY
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-446-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician