Provider Demographics
NPI:1487932646
Name:OTT, JANNA MARION (DPT)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:MARION
Last Name:OTT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:M
Other - Last Name:WILLMASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:36309 NE 91ST WAY
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-6875
Mailing Address - Country:US
Mailing Address - Phone:425-654-1425
Mailing Address - Fax:
Practice Address - Street 1:36309 NE 91ST WAY
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-6875
Practice Address - Country:US
Practice Address - Phone:425-654-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60219066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist