Provider Demographics
NPI:1881204535
Name:OTTER, MARIEL VERONICA (DNP, CRNP-MH)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:VERONICA
Last Name:OTTER
Suffix:
Gender:F
Credentials:DNP, CRNP-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1965 GREENSPRING DR STE 214
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4199
Mailing Address - Country:US
Mailing Address - Phone:443-212-8182
Mailing Address - Fax:443-558-7579
Practice Address - Street 1:1965 GREENSPRING DR STE 214
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4199
Practice Address - Country:US
Practice Address - Phone:443-212-8182
Practice Address - Fax:443-558-7579
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty