Healthcare Provider Details

I. General information

NPI: 1023455227
Provider Name (Legal Business Name): NAOMI OTANO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PIEDMONT BLVD STE 100
ROCK HILL SC
29732-1836
US

IV. Provider business mailing address

3012 GALLERIA POINTE CIR
ROCK HILL SC
29730-4587
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-2012
  • Fax:
Mailing address:
  • Phone: 803-992-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: