MEDICARE: MR. RICK ARLIN OTWELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA-216	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366495160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICK ARLIN OTWELL PA-C

Provider Business Mailing Address
First Line	:	7306 WEATHERFORD TRCE
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-5111
Country	:	US
Telephone Number	:	205-661-3938
Fax Number	:	205-661-3938

Provider Business Practice Location Address
First Line	:	1612 HIGHWAY 78 EAST
Second Line	:	SUITE 100
City	:	OXFORD
State	:	AL
Zip	:	36203-5862
Country	:	US
Telephone Number	:	256-835-4756
Fax Number	:	256-831-5736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/15/2024

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