Provider Demographics
NPI:1083045884
Name:OTTO, CASEY (AUD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:AMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 SAND HILL RD STE 302
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4946
Mailing Address - Country:US
Mailing Address - Phone:908-788-9131
Mailing Address - Fax:908-788-0945
Practice Address - Street 1:6 SAND HILL RD STE 302
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4946
Practice Address - Country:US
Practice Address - Phone:908-788-9131
Practice Address - Fax:908-788-0945
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO795231H00000X
NJ41YA00087200231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist