Provider Demographics
NPI:1316319056
Name:OTTERSON, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:OTTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5189 NETHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8240
Mailing Address - Country:US
Mailing Address - Phone:912-657-3039
Mailing Address - Fax:
Practice Address - Street 1:1850 E EGBERT ST
Practice Address - Street 2:STE 200
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2483
Practice Address - Country:US
Practice Address - Phone:303-853-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health