Provider Demographics
NPI:1245658152
Name:OTERI, SEYI JENNIFER (DPM)
Entity type:Individual
Prefix:
First Name:SEYI
Middle Name:JENNIFER
Last Name:OTERI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3230
Mailing Address - Country:US
Mailing Address - Phone:832-449-3520
Mailing Address - Fax:855-398-4568
Practice Address - Street 1:1601 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3230
Practice Address - Country:US
Practice Address - Phone:832-449-3520
Practice Address - Fax:855-398-4568
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2250213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX371517902Medicaid
TX371517903Medicaid
TX371517904Medicaid
TX371517901Medicaid