Provider Demographics
NPI:1366583429
Name:OTEY, KATRINA DANELLE (BA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:DANELLE
Last Name:OTEY
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 1:1067 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:WESTPOINT
Mailing Address - State:TN
Mailing Address - Zip Code:38486-5103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 DYER ST STE 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4551
Practice Address - Country:US
Practice Address - Phone:931-560-4242
Practice Address - Fax:931-560-4221
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health