| NPI | 1760595300 |
|---|---|
| Former Name | TINA MARIE OTTMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 2886123) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1568125) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-05-09 |