Provider Demographics
NPI:1306980305
Name:OTT, NANCY RANAE (MS, ATC, CSCS)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RANAE
Last Name:OTT
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:RANAE
Other - Last Name:WILLMERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, CSCS
Mailing Address - Street 1:831 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1738
Mailing Address - Country:US
Mailing Address - Phone:608-497-0491
Mailing Address - Fax:608-267-5966
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:MERITER ATRIUM
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-267-5883
Practice Address - Fax:608-267-5966
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI413-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer