Provider Demographics
NPI:1659068419
Name:LITTLE OTTERS LLC
Entity Type:Organization
Organization Name:LITTLE OTTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSECA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:989-708-6000
Mailing Address - Street 1:5352 WORCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-8508
Mailing Address - Country:US
Mailing Address - Phone:989-708-6000
Mailing Address - Fax:
Practice Address - Street 1:1800 S LOXLEY RD
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629
Practice Address - Country:US
Practice Address - Phone:989-708-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty