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NPI Code Detail

MEDICARE: OTTER & TROUT TRADING CO INC

MEDICARE: OTTER & TROUT TRADING CO INC
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
1225700000XMassage TherapistMA29294FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MA29294OTHERFLMASSAGE THERAPY LICENSE
2C2044OTHERFLBLUE CROSS PROVIDER #

General Provider Information

NPI Number : 1558588905
Entity Type Code : Organization
Provider Name (Legal Business Name) : OTTER & TROUT TRADING CO INC
Provider Business Mailing Address
First Line : 1623 NW 156TH AVE
Second Line :
City : GAINESVILLE
State : FL
Zip : 32609-4057
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1135 NW 23RD AVE STE F
Second Line :
City : GAINESVILLE
State : FL
Zip : 32609-3449
Country : US
Telephone Number : 352-514-2375
Fax Number :
Authorized Official
Title or Position : CEO (MASSAGE THERAPIST)
Name : KIMBERLI WHITE OTTER
Credential : LMT, ACST, NCTMB
Telephone Number : 352-485-3599
Provider Enumeration Date : 04/19/2007
Last Update Date : 08/22/2020

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Directions to “OTTER & TROUT TRADING CO INC ” Practice Location

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