| NPI | 1922163096 |
|---|---|
| Other Name | JAY LEE OTTERSTROM |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR L5316) |
| 1041C0700X Social Worker, Clinical (Licence: OR L3516) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2022-09-06 |