Most Relevant Information
Provider Data
| NPI Number: | 1003270810 |
| Provider Name: | ANGELA OTTO LAC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 16845 |
Most Important Dates
| Enumeration Date: | 04/07/2016 |
| Last Updated: | 12/09/2022 |
Provider Practice Location
431 1ST AVE W
KALISPELL
MT
599014959
Practice Location Phone/Fax
| Phone: | 4066074971 |
| Fax: |
Provider Mailing Location
1312 N MERIDIAN RD
KALISPELL
MT
599013095
Provider Mailing Phone/Fax
| Phone: | 4062576240 |
| Fax: | 4067520534 |