Healthcare Provider Details

I. General information

NPI: 1649027442
Provider Name (Legal Business Name): PRINCE OTI- AKENTEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N MAIN ST
MILLBURY MA
01527
US

IV. Provider business mailing address

31 S STOWELL ST APT 1R
WORCESTER MA
01604-5314
US

V. Phone/Fax

Practice location:
  • Phone: 508-506-8940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: