Provider Demographics
NPI:1659346310
Name:OTTER THERAPY SOLUTIONS, INC
Entity Type:Organization
Organization Name:OTTER THERAPY SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:407-808-2142
Mailing Address - Street 1:2926 S MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6925
Mailing Address - Country:US
Mailing Address - Phone:407-421-5002
Mailing Address - Fax:407-977-5089
Practice Address - Street 1:2926 S MORNINGSIDE CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6925
Practice Address - Country:US
Practice Address - Phone:407-421-5002
Practice Address - Fax:407-977-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6652235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889465500Medicaid