Provider Demographics
NPI:1588761027
Name:OTTEN, DIANNE M (PT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:M
Last Name:OTTEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-985-3700
Mailing Address - Fax:513-985-3706
Practice Address - Street 1:8311 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2227
Practice Address - Country:US
Practice Address - Phone:513-985-3700
Practice Address - Fax:513-985-3706
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-005034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000354584OtherANTHEM
7214214OtherAETNA
OH2328743Medicaid
OHOT0889313Medicare ID - Type Unspecified