Provider Demographics
NPI:1508594144
Name:OTOO, TIMOTHY WK
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:WK
Last Name:OTOO
Suffix:
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 1:155A OAK ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3317
Mailing Address - Country:US
Mailing Address - Phone:800-366-7732
Mailing Address - Fax:
Practice Address - Street 1:155A OAK ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3317
Practice Address - Country:US
Practice Address - Phone:800-366-7732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor