Active NPI
Paul Stearns Otto, PH D
- Psychologist
- Ukiah, CA
National Provider Identifier
1407932718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 9139
- Practice address
- 205 W Clay St
Ukiah, CA 95482-5452 - Phone
- (707) 462-1644
- Fax
- (707) 462-5881
- NPI assigned
- Oct 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 9139 | CA | Primary |
Addresses
Primary practice location
205 W Clay St
Ukiah, CA 95482-5452
Mailing address
735 Walnut Ave
Ukiah, CA 95482-4240
Phone (707) 468-8348
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 9139 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407932718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "735 WALNUT AVE",
"city": "UKIAH",
"state": "CA",
"postal_code": "954824240",
"telephone_number": "707-468-8348",
"fax_number": "707-462-5881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 W CLAY ST",
"city": "UKIAH",
"state": "CA",
"postal_code": "954825452",
"telephone_number": "707-462-1644",
"fax_number": "707-462-5881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTO",
"first_name": "PAUL",
"middle_name": "STEARNS",
"name_prefix": "Dr.",
"credential": "PH D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 9139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ukiah, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.