Provider Demographics
NPI:1740006394
Name:OTIM, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:OTIM
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 1:42 MARLBORO ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1739
Mailing Address - Country:US
Mailing Address - Phone:267-897-2661
Mailing Address - Fax:
Practice Address - Street 1:5 PAUL X TIVNAN DR
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2126
Practice Address - Country:US
Practice Address - Phone:267-897-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical