Basic Information
| Provider Information | |||||||||
| NPI: | 1669609053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTENBREIT | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.A., LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34807 MICHELLE DR | ||||||||
| Address2: | |||||||||
| City: | ROMULUS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481743437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349416217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 888 W BIG BEAVER RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480844736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482448644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 06/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301008210 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.