Nicole Christine Otto

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

10571 Issued in WI

Practice address

6025 N Green Bay Ave Uppr Level
Glendale, WI 53209-3811

Phone

(414) 247-0801

Fax

(414) 247-0816

NPI assigned

Oct 18, 2021

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Richard Kneip, PH.D., P.C.

  • Community/Behavioral Health Agency
  • Clarkston, MI
  • NPI 1679739700

  WI

  Medicare reassignment NPD
• Sebastian Family Psycholgy Practice

  • Professional Counselor
  • Glendale, WI
  • NPI 1124441373
  NPD (past)
• Sebastian Family Psycholgy Practice

  • Mental Health Counselor
  • Glendale, WI
  • NPI 1316360092
  NPD (past)

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

{
    "created_epoch": "1634515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1780347674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 N GREEN BAY AVE UPPR LEVEL",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093811",
            "telephone_number": "414-247-0801",
            "fax_number": "414-247-0816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 N GREEN BAY AVE UPPR LEVEL",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532093811",
            "telephone_number": "414-247-0801",
            "fax_number": "414-247-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "NICOLE",
        "middle_name": "CHRISTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-18",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "10571",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "10571",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Orthopaedic Hospital of Wisconsin, LLC
• Kayla Ortiz, APNP
• Mallikarjuna Subramanyam Oruganti, MD
• Jocelyn O Osborne
• OT Bestie LLC
• Carlie Owens, DPT
• Nicole Annmarie Owens, APNP
• Losheni Paramasivam
• Janine Marie Park
• Amy Parry, PT

• Professional Counselor in Glendale, WI
• Providers in Glendale, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.