MEDICARE: OTTER HOME AND HEALTH, LLC

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	163WH0200X	Home Health Registered Nurse

General Provider Information

NPI Number	:	1487596888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTER HOME AND HEALTH, LLC

Provider Business Mailing Address
First Line	:	3605 GRANT CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5800
Country	:	US
Telephone Number	:	573-356-3350
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 GRANT CT
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5800
Country	:	US
Telephone Number	:	573-356-3350
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOLLY TENNYSON
Credential	:	RN
Telephone Number	:	573-356-3350

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “OTTER HOME AND HEALTH, LLC ” Practice Location

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