Provider Demographics
NPI:1457384570
Name:OTT, CHRISTIANA (MSPT)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:CHRISTIANA
Other - Middle Name:
Other - Last Name:MCCORMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 W 29TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2797
Mailing Address - Country:US
Mailing Address - Phone:970-663-6142
Mailing Address - Fax:970-635-3087
Practice Address - Street 1:2211 S COLLEGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1489
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC492638Medicare PIN