Provider Demographics
NPI:1043458557
Name:OTOYA, NATALIE SYLVIA (STUDENT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SYLVIA
Last Name:OTOYA
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6025
Mailing Address - Country:US
Mailing Address - Phone:703-593-1906
Mailing Address - Fax:
Practice Address - Street 1:2327 SHENANDOAH AVE.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:703-593-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4297111N00000X
SC3701111N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program