Provider Demographics
NPI:1659998599
Name:OOTW, INC.
Entity Type:Organization
Organization Name:OOTW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:THOELECKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:847-657-7900
Mailing Address - Street 1:6449 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2604
Mailing Address - Country:US
Mailing Address - Phone:847-657-7900
Mailing Address - Fax:
Practice Address - Street 1:6449 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2604
Practice Address - Country:US
Practice Address - Phone:847-657-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Single Specialty