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General NPI Number Information
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NPI Number | 1659068419
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Entity Type | Organization
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Legal Business Name | LITTLE OTTERS LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 1800 S LOXLEY RD
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629
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Country | US
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Telephone | 989-708-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 5352 WORCHESTER WAY
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City | GLADWIN
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State | MI
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Zip | 48624-8508
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Country | US
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Telephone | 989-708-6000
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | JESSECA SUE WOOD
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Credential | MSOT
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Telephone | 989-708-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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