Provider Demographics
NPI:1063747673
Name:OTT, COLLETTE K (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:K
Last Name:OTT
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:COLLETTE
Other - Middle Name:K
Other - Last Name:SARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:331 NEWMAN SPRINGS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5792
Mailing Address - Country:US
Mailing Address - Phone:732-807-0877
Mailing Address - Fax:
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2200
Practice Address - Fax:732-923-2272
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00229500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant