Provider Demographics
NPI:1366417883
Name:OTT, CHRISTINE QUATRO (DO)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:QUATRO
Last Name:OTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9545 N BEACH ST STE 133
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-6471
Mailing Address - Country:US
Mailing Address - Phone:817-431-1017
Mailing Address - Fax:817-431-1032
Practice Address - Street 1:9545 N. BEACH STREET SUITE 133
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6471
Practice Address - Country:US
Practice Address - Phone:174-311-0178
Practice Address - Fax:817-431-1032
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8341207X00000X, 207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPOOT98P2Medicaid
TX1106049-01Medicaid
TXPOOT98P2Medicaid