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NPI Code Detail

MEDICARE: OTOOTA L ELIESA

MEDICARE: OTOOTA L ELIESA
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
1101Y00000XCounselor

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 : 1912207796
Entity Type Code : Individual
Provider Name (Legal Business Name) : OTOOTA L ELIESA
Provider Business Mailing Address
First Line : PO BOX 651372
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84165-1372
Country : US
Telephone Number : 801-474-2500
Fax Number : 801-474-9117
Provider Business Practice Location Address
First Line : 3030 S MAIN ST STE 400
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-3578
Country : US
Telephone Number : 801-474-2500
Fax Number : 801-474-9117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2010
Last Update Date : 10/27/2010

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Directions to “ OTOOTA L ELIESA ” Practice Location

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