Provider Demographics
NPI:1316652498
Name:OTERO, DYLEEN MARIE (LMT)
Entity type:Individual
Prefix:
First Name:DYLEEN
Middle Name:MARIE
Last Name:OTERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320A CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2917
Mailing Address - Country:US
Mailing Address - Phone:804-520-7246
Mailing Address - Fax:
Practice Address - Street 1:320A CHARLES H DIMMOCK PKWY
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2917
Practice Address - Country:US
Practice Address - Phone:804-520-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA811871132OtherCHIROPRACTIC