Healthcare Provider Details

I. General information

NPI: 1366495160
Provider Name (Legal Business Name): RICK ARLIN OTWELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/15/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 HIGHWAY 78 EAST SUITE 100
OXFORD AL
36203-5862
US

IV. Provider business mailing address

7306 WEATHERFORD TRCE
TRUSSVILLE AL
35173-5111
US

V. Phone/Fax

Practice location:
  • Phone: 256-835-4756
  • Fax: 256-831-5736
Mailing address:
  • Phone: 205-661-3938
  • Fax: 205-661-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-216
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: