Provider Demographics
NPI:1114456076
Name:OTTENS, CASEY
Entity type:Individual
Prefix:MISS
First Name:CASEY
Middle Name:
Last Name:OTTENS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:OTTENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2710
Mailing Address - Country:US
Mailing Address - Phone:631-487-1944
Mailing Address - Fax:
Practice Address - Street 1:142 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2710
Practice Address - Country:US
Practice Address - Phone:631-487-1944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024406225700000X
NY005429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist