Provider Demographics
NPI:1659740058
Name:OTVEST, LLC
Entity Type:Organization
Organization Name:OTVEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:269-329-3287
Mailing Address - Street 1:4646 WISHING WELL CT
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4607
Mailing Address - Country:US
Mailing Address - Phone:269-329-3287
Mailing Address - Fax:269-324-2012
Practice Address - Street 1:4646 WISHING WELL CT
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4607
Practice Address - Country:US
Practice Address - Phone:269-329-3287
Practice Address - Fax:269-324-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment