Provider Demographics
NPI:1821856634
Name:OTWELL, FARREN MONTANA (RD, LMT)
Entity type:Individual
Prefix:MRS
First Name:FARREN
Middle Name:MONTANA
Last Name:OTWELL
Suffix:
Gender:F
Credentials:RD, LMT
Other - Prefix:MS
Other - First Name:FARREN
Other - Middle Name:MONTANA
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LMT
Mailing Address - Street 1:300 TWINING ST BLDG 760
Mailing Address - Street 2:
Mailing Address - City:MAXWELL AFB
Mailing Address - State:AL
Mailing Address - Zip Code:36112-6027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 TWINING ST BLDG 760
Practice Address - Street 2:
Practice Address - City:MAXWELL AFB
Practice Address - State:AL
Practice Address - Zip Code:36112-6027
Practice Address - Country:US
Practice Address - Phone:334-953-5200
Practice Address - Fax:334-953-8607
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3847225700000X
AL5123133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist