Healthcare Provider Details

I. General information

NPI: 1396656633
Provider Name (Legal Business Name): OTG WELLNESS SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S ONEIDA ST STE 150
DENVER CO
80224-2500
US

IV. Provider business mailing address

2121 S ONEIDA ST STE 150
DENVER CO
80224-2500
US

V. Phone/Fax

Practice location:
  • Phone: 303-369-1979
  • Fax:
Mailing address:
  • Phone: 303-369-1979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATASHANNA MADISON
Title or Position: OWNER
Credential:
Phone: 303-369-1979