Provider Demographics
NPI:1386424521
Name:OTTO, GRACE LYNN
Entity type:Individual
Prefix:
First Name:GRACE LYNN
Middle Name:
Last Name:OTTO
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 1:1438 LILIHA ST APT 311
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-6111
Mailing Address - Country:US
Mailing Address - Phone:808-721-2066
Mailing Address - Fax:
Practice Address - Street 1:1438 LILIHA ST APT 311
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-6111
Practice Address - Country:US
Practice Address - Phone:808-721-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician