Basic Information
| Provider Information | |||||||||
| NPI: | 1366893026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTAVI | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1337 PAGE ST APT 6 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941173053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073222392 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3075 ADELINE ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108481112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2016 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 101391 | AK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.