# LARRY O OTWELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1417941329
- **Gender:** Man
- **Credential:** AUD CCCA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | AY370 | FL | Yes |

## Other

- **Enumeration date:** 09/07/2005
- **Last updated:** 04/03/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 600185800 | — | FL |
| 05 | — | 600237400 | — | FL |
| 01 | — | AD782 | MEDICARE GROUP | FL |
| 01 | — | K0176 | MEDICARE OLD PTAN | FL |
| 01 | — | S1844 | BCBS | FL |