Basic Information
| Provider Information | |||||||||
| NPI: | 1033594205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTTEY | ||||||||
| FirstName: | THOMAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30466 DATE ROW | ||||||||
| Address2: | |||||||||
| City: | BIG PINE KEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330434732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | 3054349041 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 41ST STREET OCEAN | ||||||||
| Address2: | |||||||||
| City: | MARATHON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330502373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054347660 | ||||||||
| FaxNumber: | 3054349041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN9406645 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.