Provider Demographics
NPI:1568602308
Name:OTTLEIN, GEORGE R (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:R
Last Name:OTTLEIN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22138 CANDLE CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4639
Mailing Address - Country:US
Mailing Address - Phone:561-852-8225
Mailing Address - Fax:
Practice Address - Street 1:22138 CANDLE CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4639
Practice Address - Country:US
Practice Address - Phone:561-852-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA#53739225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist