Healthcare Provider Details

I. General information

NPI: 1508594144
Provider Name (Legal Business Name): TIMOTHY WK OTOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 AIRPORT RD
FITCHBURG MA
01420-8142
US

IV. Provider business mailing address

155 AIRPORT RD
FITCHBURG MA
01420-8142
US

V. Phone/Fax

Practice location:
  • Phone: 978-906-0270
  • Fax: 857-615-7159
Mailing address:
  • Phone: 978-906-0270
  • Fax: 857-615-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: