Provider Demographics
NPI:1962622563
Name:OTT, PAULA G (RN, RCS)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:OTT
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7387 COUNTY RD W
Mailing Address - Street 2:
Mailing Address - City:GREENLEAF
Mailing Address - State:WI
Mailing Address - Zip Code:54126-9483
Mailing Address - Country:US
Mailing Address - Phone:920-864-2348
Mailing Address - Fax:920-864-2348
Practice Address - Street 1:7387 COUNTY RD W
Practice Address - Street 2:
Practice Address - City:GREENLEAF
Practice Address - State:WI
Practice Address - Zip Code:54126-9483
Practice Address - Country:US
Practice Address - Phone:920-864-2348
Practice Address - Fax:920-864-2348
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38282200Medicaid