Provider Demographics
NPI:1386149623
Name:OTTER, SARAH FREDERIKE (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:FREDERIKE
Last Name:OTTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8603 E ROYAL PALM RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4389
Mailing Address - Country:US
Mailing Address - Phone:480-427-0678
Mailing Address - Fax:480-451-9098
Practice Address - Street 1:8603 E ROYAL PALM RD STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4389
Practice Address - Country:US
Practice Address - Phone:480-427-0678
Practice Address - Fax:480-900-8426
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042950207Q00000X
CA20A23271207Q00000X
390200000X
AZ008979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program