Provider Demographics
NPI:1841755857
Name:OTHMER, NORMA
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:OTHMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22707 RODERICK DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4098
Mailing Address - Country:US
Mailing Address - Phone:813-244-0107
Mailing Address - Fax:
Practice Address - Street 1:22707 RODERICK DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4098
Practice Address - Country:US
Practice Address - Phone:813-244-0107
Practice Address - Fax:813-388-2818
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
FL6906552310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL735424Medicaid