Provider Demographics
NPI:1932280401
Name:OTI, ELECHI N (MD AND PA-C)
Entity Type:Individual
Prefix:
First Name:ELECHI
Middle Name:N
Last Name:OTI
Suffix:
Gender:F
Credentials:MD AND PA-C
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:O
Other - Last Name:IWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD AND PA-C
Mailing Address - Street 1:2664 WHISPERING TRL
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-6901
Mailing Address - Country:US
Mailing Address - Phone:214-718-0650
Mailing Address - Fax:214-494-2602
Practice Address - Street 1:2664 WHISPERING TRL
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6901
Practice Address - Country:US
Practice Address - Phone:214-718-0650
Practice Address - Fax:214-494-2602
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03161363A00000X
GARTP 0061432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry