Provider Demographics
NPI:1841825940
Name:OTULANA, RUTHIE
Entity type:Individual
Prefix:MRS
First Name:RUTHIE
Middle Name:
Last Name:OTULANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8310 BOGEY DR APT 106
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-5318
Mailing Address - Country:US
Mailing Address - Phone:901-495-0148
Mailing Address - Fax:
Practice Address - Street 1:4041 KNIGHT ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2128
Practice Address - Country:US
Practice Address - Phone:901-572-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker