Provider Demographics
NPI:1124990015
Name:OTTIS, ANNETTE MARIE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:OTTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5227
Mailing Address - Country:US
Mailing Address - Phone:402-742-0311
Mailing Address - Fax:
Practice Address - Street 1:309 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5227
Practice Address - Country:US
Practice Address - Phone:402-742-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No372600000XNursing Service Related ProvidersAdult Companion