MEDICARE: ROBERT G OTOS OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	101915	MN

General Provider Information

NPI Number	:	1073123873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT G OTOS OT

Provider Business Mailing Address
First Line	:	8700 VIRGINIA CIR N
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2455
Country	:	US
Telephone Number	:	612-790-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 VIRGINIA CIR N
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55426-2455
Country	:	US
Telephone Number	:	612-790-1114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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