Provider Demographics
NPI:1659536167
Name:O.T. INC
Entity Type:Organization
Organization Name:O.T. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPKA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:810-730-0783
Mailing Address - Street 1:2180 WESTERN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9447
Mailing Address - Country:US
Mailing Address - Phone:810-487-1526
Mailing Address - Fax:810-487-1529
Practice Address - Street 1:2180 WESTERN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9447
Practice Address - Country:US
Practice Address - Phone:810-487-1526
Practice Address - Fax:810-487-1529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003930261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities