Provider Demographics
NPI:1699955369
Name:OTT, TONIE SUE (LSW)
Entity type:Individual
Prefix:MS
First Name:TONIE
Middle Name:SUE
Last Name:OTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 STATE HIGHWAY 108
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-8200
Mailing Address - Country:US
Mailing Address - Phone:419-335-3732
Mailing Address - Fax:419-335-3462
Practice Address - Street 1:7320 STATE HIGHWAY 108
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-8200
Practice Address - Country:US
Practice Address - Phone:419-335-3732
Practice Address - Fax:419-335-3462
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS29513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS29513OtherOHIO SOCIAL BOARD