Healthcare Provider Details

I. General information

NPI: 1649147380
Provider Name (Legal Business Name): MILDRED OCHISO OTSIENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 OAK ST
MIDDLEBORO MA
02346-2078
US

IV. Provider business mailing address

479 COUNTY ST
TAUNTON MA
02780-3601
US

V. Phone/Fax

Practice location:
  • Phone: 508-923-5300
  • Fax:
Mailing address:
  • Phone: 508-923-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN272235
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: