Provider Demographics
NPI:1295487098
Name:MCDUFFIE, OTIS L
Entity type:Individual
Prefix:
First Name:OTIS
Middle Name:L
Last Name:MCDUFFIE
Suffix:
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 1:805 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5521
Mailing Address - Country:US
Mailing Address - Phone:352-434-5229
Mailing Address - Fax:
Practice Address - Street 1:805 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731-5521
Practice Address - Country:US
Practice Address - Phone:352-434-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child