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General NPI Number Information
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NPI Number | 1053652636
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Entity Type | Organization
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Legal Business Name | BESSIE OTT
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Dates
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Enumeration Date | 03/07/2013
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Last Update Date | 03/07/2013
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Provider Practice Location Address
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Address Line | 111 S MAIN ST
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City | MCALESTER
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State | OK
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Zip | 74501-5363
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Country | US
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Telephone | 918-423-5204
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Fax |
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Provider Business Mailing Address
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Address Line | 2940 N BIRCH ST
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City | MCALESTER
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State | OK
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Zip | 74501-2226
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Country | US
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Telephone | 918-429-2353
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER 1
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Name | MRS. BESSIE MAE OTT
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Credential |
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Telephone | 918-429-2353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | K082489707
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License Number State | OK
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