Healthcare Provider Details

I. General information

NPI: 1265953533
Provider Name (Legal Business Name): BETTY U OTUONYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 RODEO DR
TALLAHASSEE FL
32311-8548
US

IV. Provider business mailing address

1744 RODEO DR
TALLAHASSEE FL
32311-8548
US

V. Phone/Fax

Practice location:
  • Phone: 850-661-6894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT18496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: