Krystel Dawn Otto, MS,ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

883039 Issued in WI

Practice address

3509 Dewey St
Manitowoc, WI 54220-5813

Phone

(920) 686-5731

NPI assigned

Mar 28, 2007

Sex

Female

Sole proprietor

No

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": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1598884140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14104 ROSELAWN RD",
            "city": "VALDERS",
            "state": "WI",
            "postal_code": "542459582",
            "telephone_number": "920-410-1656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 DEWEY ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542205813",
            "telephone_number": "920-686-5731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "KRYSTEL",
        "middle_name": "DAWN",
        "credential": "MS,ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-28",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "883039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane M Oppeneer, APNP
• Michael Owen Orchekowski, DDS
• Orthopaedic Associates of Manitowoc LTD
• Orthopedic & Spine Therapy of Brillion, SC
• Orthopedic & Spine Therapy of Brillion, SC
• Kiley Ouradnik, RN
• Debra Kathleen Paasch, REGISTERED NURSE
• Jennifer Pahmeier
• Shirley Paider, RDH
• Pooja Bharat Patel, MD, MBS

• Athletic Trainer in Manitowoc, WI
• Providers in Manitowoc, WI by specialty
• Athletic Trainer in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.