Provider Demographics
NPI:1174990972
Name:OTTATI, ALICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:OTTATI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8139 OLD TROY PIKE # 1046
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1067
Mailing Address - Country:US
Mailing Address - Phone:512-910-5090
Mailing Address - Fax:
Practice Address - Street 1:1685 MULBERRY WOODS CT
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9501
Practice Address - Country:US
Practice Address - Phone:937-367-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39344103TC0700X
VA0810005413103TC0700X
OHP.08275.MIL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical