Provider Demographics
NPI:1972620870
Name:MACKLIN, OTEKA (BA)
Entity type:Individual
Prefix:MS
First Name:OTEKA
Middle Name:
Last Name:MACKLIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ARLINGTON AVE
Mailing Address - Street 2:200
Mailing Address - City:L.A.
Mailing Address - State:CA
Mailing Address - Zip Code:90018
Mailing Address - Country:US
Mailing Address - Phone:323-737-3900
Mailing Address - Fax:323-737-3993
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1336
Practice Address - Country:US
Practice Address - Phone:323-737-3900
Practice Address - Fax:323-737-3993
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker