Provider Demographics
NPI:1407610462
Name:DOTSON, LARRY OTIS JR
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:OTIS
Last Name:DOTSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 TERMINAL WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2121
Mailing Address - Country:US
Mailing Address - Phone:775-378-5536
Mailing Address - Fax:
Practice Address - Street 1:3365 TOLEDO CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6207
Practice Address - Country:US
Practice Address - Phone:775-622-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide