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General NPI Number Information
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NPI Number | 1457548240
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Entity Type | Individual
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Provider Name | EMMEKEN GODELIEVE OTTE M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 901 W HAMILTON ST
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City | OLNEY
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State | TX
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Zip | 76374-1725
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Country | US
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Telephone | 940-564-5521
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Fax |
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Provider Business Mailing Address
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Address Line | 100 S AVENUE M
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City | OLNEY
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State | TX
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Zip | 76374-1642
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Country | US
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Telephone | 940-564-3546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N7733
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N7733
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License Number State | TX
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