Provider Demographics
NPI:1063398774
Name:OTLO, ABBIE (DC)
Entity type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:
Last Name:OTLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1092 RSCR 1275
Mailing Address - Street 2:
Mailing Address - City:EMORY
Mailing Address - State:TX
Mailing Address - Zip Code:75440-6922
Mailing Address - Country:US
Mailing Address - Phone:715-554-0337
Mailing Address - Fax:715-554-0337
Practice Address - Street 1:387 S TRADE DAYS BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-3314
Practice Address - Country:US
Practice Address - Phone:214-884-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor