Provider Demographics
NPI:1942732508
Name:BOOKER, OTIS R JR
Entity Type:Individual
Prefix:MR
First Name:OTIS
Middle Name:R
Last Name:BOOKER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 N ORACLE RD
Mailing Address - Street 2:# 87
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-7447
Mailing Address - Country:US
Mailing Address - Phone:520-249-6226
Mailing Address - Fax:
Practice Address - Street 1:8851 N ORACLE RD
Practice Address - Street 2:# 87
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7447
Practice Address - Country:US
Practice Address - Phone:520-249-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9902APTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant