RUSSELL RAYMOND OTTO (Credential# 1651331) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is April 1, 2020. The license expiration date date is March 31, 2021. The license status is ACTIVE.
RUSSELL RAYMOND OTTO is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.004505. The credential type is physician assistant. The effective date is April 1, 2020. The expiration date is March 31, 2021. The business address is 140 Arbutus Street, Middletown, CT 06457. The current status is active.
| Licensee Name | RUSSELL RAYMOND OTTO |
| Credential ID | 1651331 |
| Credential Number | 23.004505 |
| Credential Type | Physician Assistant |
| Business Address |
140 Arbutus Street Middletown CT 06457 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2019-07-05 |
| Effective Date | 2020-04-01 |
| Expiration Date | 2021-03-31 |
| Refresh Date | 2020-01-06 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 1674759 | CSP.0071868 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2019-07-10 | 2019-07-10 - 2021-02-28 | ACTIVE |
| Street Address | 140 ARBUTUS STREET |
| City | MIDDLETOWN |
| State | CT |
| Zip Code | 06457 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Gina M Jones | 140 Arbutus Street, Middletown, CT 06457 | Notary Public Appointment | 2018-05-01 ~ 2023-04-30 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Elizabeth M Mailhot | 177 Timber Ridge Rd, Middletown, CT 06457 | Dental Hygienist | 2020-08-01 ~ 2021-07-31 |
| Rebecca S Fennessy | 22 Keefe Ln, Middletown, CT 06457 | Licensed Clinical Social Worker | 2020-07-01 ~ 2021-06-30 |
| Eloise M Gagnon | 538 Bow Lane, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-08-01 ~ 2022-07-31 |
| Salvatore Dimauro | 245 Dekoven Dr, Middletown, CT 06457 | Public Weigher | 2020-07-01 ~ 2021-06-30 |
| Frank L Wright | 261 Spencer Dr, Middletown, CT 06457 | Barber | 2020-08-01 ~ 2022-07-31 |
| Gino A Cardella | 50 Sonoma Lane, Middletown, CT 06457 | Real Estate Salesperson | ~ |
| Shannon Lee Mcquillan | 5 Forest Glen Circle, Middletown, CT 06457 | Registered Nurse | 2020-06-26 ~ 2020-09-30 |
| Lori Dimauro · Carta | 244 Chamberlain Hill Road, Middletown, CT 06457 | Hairdresser/cosmetician | 2020-09-01 ~ 2022-08-31 |
| Gail A Corrow | 85 Dora Dr, Middletown, CT 06457 | Real Estate Salesperson | 2020-06-01 ~ 2021-05-31 |
| Mariter V Perez | 8 Moss Glen, Middletown, CT 06457 | Registered Nurse | 2020-08-01 ~ 2021-07-31 |
| Find all Licenses in zip 06457 | |||
| City | MIDDLETOWN |
| Zip Code | 06457 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + MIDDLETOWN |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Raymond J Anton Md | Raymond J. Anton, M.d., Russell, MA 01071 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
| Raymond R Russell IIi | 333 Cedar St # 3, New Haven, CT 06510-3206 | Physician/surgeon | 2017-06-01 ~ 2018-05-31 |
| Beth Degarmo | 328 Russell St Apt 2, Madison, WI 53704-5313 | Physician Assistant | 2019-04-01 ~ 2020-03-31 |
| Russell Longendorfer | 8 Alana Drive, Sutton, MA 01590 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Julie Brooke Forster | 5 Russell Rd, Cromwell, CT 06416-2470 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Marybeth S Markham | 700 Russell Road, Westfield, MA 01085 | Physician Assistant | 2000-06-06 ~ 2000-08-31 |
| Stephen J Burgess Pa | 218 Russell Street, Hadley, MA 01035 | Physician Assistant | 1998-09-08 ~ 1999-09-30 |
| Concetta M Russell · Vella | 44 Granite Drive, Penfield, NY 14526 | Physician Assistant | 2006-07-07 ~ 2007-07-31 |
| Raymond M Sheehan | 133 Seemans Ln Apt 8, Milford, CT 06460-4373 | Physician Assistant | 2019-01-01 ~ 2019-12-31 |
| Raymond S Amos | 28 Mueller Drive, Hamden, CT 06514 | Physician Assistant | 2009-08-01 ~ 2010-07-31 |
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| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).