Healthcare Provider Details

I. General information

NPI: 1972320729
Provider Name (Legal Business Name): OTW F.A.S.T LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5127 SHELLBARK CT
GROVEPORT OH
43125-9399
US

IV. Provider business mailing address

5127 SHELLBARK CT
GROVEPORT OH
43125-9399
US

V. Phone/Fax

Practice location:
  • Phone: 614-634-1506
  • Fax:
Mailing address:
  • Phone: 614-634-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHAVONA R BARNES
Title or Position: OWNER
Credential:
Phone: 614-634-1506