Provider Demographics
NPI:1427443423
Name:OTT, BOBBIE (RN)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 S FM 1988
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-4456
Mailing Address - Country:US
Mailing Address - Phone:936-967-3636
Mailing Address - Fax:936-967-3635
Practice Address - Street 1:1437 S FM 1988
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-4456
Practice Address - Country:US
Practice Address - Phone:936-967-3636
Practice Address - Fax:936-967-3635
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139652310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility