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General NPI Number Information
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NPI Number | 1841678109
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Entity Type | Individual
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Provider Name | LEONARD HERBERT OTWORTH IV D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 11/15/2018
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Provider Practice Location Address
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Address Line | 2001 SCIOTO TRL STE 300
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City | PORTSMOUTH
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State | OH
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Zip | 45662-2845
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Country | US
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Telephone | 740-353-6390
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Fax | 740-353-6290
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Provider Business Mailing Address
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Address Line | PO BOX 1595
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City | ASHLAND
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State | KY
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Zip | 41105-1595
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Country | US
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Telephone | 606-408-6200
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Fax | 606-408-6612
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34.012427
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License Number State | OH
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