Otto Mazzoni III, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

111590 Issued in TX

Practice address

2407 W Main St # 82
Clarksville, TX 75426-3327

Phone

(903) 427-3821

NPI assigned

Jun 29, 2018

Last updated

Jun 29, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530230400000",
    "number": "1245725423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "268 WHISPERING PINE TRL",
            "city": "MOUNT VERNON",
            "state": "TX",
            "postal_code": "754574957",
            "telephone_number": "903-563-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 W MAIN ST # 82",
            "city": "CLARKSVILLE",
            "state": "TX",
            "postal_code": "754263327",
            "telephone_number": "903-427-3821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZONI",
        "first_name": "OTTO",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-29",
        "last_updated": "2018-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "111590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerri Huddleston, FNP-BC
• Kristen Leigh Janes, MSN, APRN, FNP-C
• Kyle J Keeley, PT
• Rajkumar Maria Susai
• Curtis Montgomery Mayo Jr., PTA
• Sarah Jeanette Morris, APRN
• Bacharanianda Chengappa Muthappa, M.D., F.R.C.S.
• Nexion Health at Bogata, Inc. (Regency Healthcare and Rehabilitation Center at Red River)
• Paris Medical Supply, Inc. (Pro Care Services)
• Misty Dawn Perez, PHARM D

• Speech-Language Pathologist in Clarksville, TX
• Providers in Clarksville, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.