MEDICARE: LORI OTTER

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	163W00000X	Registered Nurse	552998	NY

General Provider Information

NPI Number	:	1487403770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI OTTER

Provider Business Mailing Address
First Line	:	6050 STATE ROUTE 26
Second Line	:
City	:	ROME
State	:	NY
Zip	:	13440-8067
Country	:	US
Telephone Number	:	315-794-5219
Fax Number	:

Provider Business Practice Location Address
First Line	:	6050 STATE ROUTE 26
Second Line	:
City	:	ROME
State	:	NY
Zip	:	13440-8067
Country	:	US
Telephone Number	:	315-794-5219
Fax Number	:

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

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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Directions to “ LORI OTTER ” Practice Location

Language	Start Address	Practice Location

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