=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659346310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OTTER THERAPY SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2006
-----------------------------------------------------
Last Update Date | 08/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2926 S MORNINGSIDE CT
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-6925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-421-5002
-----------------------------------------------------
Fax | 407-977-5089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2926 S MORNINGSIDE CT
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-6925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-421-5002
-----------------------------------------------------
Fax | 407-977-5089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. KAREN M SMALL
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 407-808-2142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA 6652
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------