Provider Demographics
NPI:1942575055
Name:OTERO, ELIZABETH (MT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 ROYAL PALM BLVD
Mailing Address - Street 2:APT-204
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7368
Mailing Address - Country:US
Mailing Address - Phone:786-382-3645
Mailing Address - Fax:
Practice Address - Street 1:7301 NW 4TH ST
Practice Address - Street 2:SUITE-101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2234
Practice Address - Country:US
Practice Address - Phone:954-626-0944
Practice Address - Fax:954-533-6534
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55796225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist