Provider Demographics
NPI:1144461161
Name:OTTINO, BRITTANY N (PSYD)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:N
Last Name:OTTINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:NIICHOLE
Other - Last Name:THOMAS-OTTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 19674
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9674
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-585-6890
Practice Address - Street 1:5220 S 6TH STREET RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5735
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-585-6890
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007660103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400159197Medicare PIN