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NPI Code Detail

MEDICARE: TERESA OTA

MEDICARE: TERESA OTA
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
1207L00000XAnesthesiology Physician295818-1205UT

Other Identifiers

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

General Provider Information

NPI Number : 1467450502
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA OTA
Provider Business Mailing Address
First Line : PO BOX 27688
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0688
Country : US
Telephone Number : 801-534-1360
Fax Number : 801-366-9883
Provider Business Practice Location Address
First Line : 3838 S 700 E
Second Line : STE 200
City : SALT LAKE CITY
State : UT
Zip : 84106-1466
Country : US
Telephone Number : 801-261-4988
Fax Number : 801-269-9427
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 07/08/2007

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Directions to “ TERESA OTA ” Practice Location

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