Healthcare Provider Details

I. General information

NPI: 1518434331
Provider Name (Legal Business Name): OTONIEL ESPINOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 BURR ST
SCHERERVILLE IN
46375-3567
US

IV. Provider business mailing address

7770 BURR ST
SCHERERVILLE IN
46375-3567
US

V. Phone/Fax

Practice location:
  • Phone: 219-789-9009
  • Fax:
Mailing address:
  • Phone: 219-789-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06004950A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: