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General NPI Number Information
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NPI Number | 1669861373
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Entity Type | Organization
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Legal Business Name | OCOEE MEDICAL LLC
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/19/2015
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Provider Practice Location Address
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Address Line | 4220 OCOEE ST N
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City | CLEVELAND
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State | TN
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Zip | 37312-4829
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Country | US
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Telephone | 423-479-4220
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Fax | 423-339-0294
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Provider Business Mailing Address
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Address Line | 4220 OCOEE ST N
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City | CLEVELAND
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State | TN
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Zip | 37312-4829
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Country | US
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Telephone | 423-479-4220
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Fax | 423-339-0294
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OTIS BRANDON FORRESTER
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Credential | D.C.
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Telephone | 423-479-4220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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