MEDICARE: OTASH BARRETT

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	172A00000X	Driver	B630643750190	FL

General Provider Information

NPI Number	:	1477315877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OTASH BARRETT

Provider Business Mailing Address
First Line	:	13156 ROYAL PINES AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-9321
Country	:	US
Telephone Number	:	813-516-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	13156 ROYAL PINES AVE
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-9321
Country	:	US
Telephone Number	:	813-516-7886
Fax Number	:

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

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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Directions to “ OTASH BARRETT ” Practice Location

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