Otwell, Larry O

Otwell, Larry O is an sole proprietor health care provider with primary practice located at 2518 S Highway 77 Ste A , Lynn Haven FL 32444-4730. He recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as his primary health care specialty. Otwell, Larry O can be contacted via phone (850) 769-2705.

Contact Information

Primary practice address
2518 S Highway 77 Ste A Lynn Haven FL 32444-4730
Phone: (850) 769-2705
Fax: (850) 769-1097
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X AY370 Florida

Profile Details

NPI number 1417941329
LBN Legal business name Otwell, Larry O
Credentials AUD CCCA
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 7th, 2005
Last updated Apr 3rd, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417941329 NPPES
Florida Other AD782 MEDICARE GROUP
Florida Other K0176 MEDICARE GROUP
Florida Other S1844 MEDICARE GROUP
Florida MEDICAID 600185800 MEDICARE GROUP
Florida MEDICAID 600237400 MEDICARE GROUP

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