Provider Demographics
NPI:1073123873
Name:OTOS, ROBERT G (OT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:OTOS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 VIRGINIA CIR N
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-2455
Mailing Address - Country:US
Mailing Address - Phone:612-790-1114
Mailing Address - Fax:
Practice Address - Street 1:8700 VIRGINIA CIR N
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-2455
Practice Address - Country:US
Practice Address - Phone:612-790-1114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101915225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist