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Organization
OTTER & TROUT TRADING CO INC
Active
Organization
OTTER & TROUT TRADING CO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLI WHITE OTTER LMT, ACST, NCTMB (CEO (MASSAGE THERAPIST))
(352) 485-3599
Entity
Organization
Contact information
Practice address
1135 NW 23RD AVE STE F, GAINESVILLE, FL 32609-3449
(352) 514-2375
Mailing address
1623 NW 156TH AVE, GAINESVILLE, FL 32609-4057
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA29294
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C2044
BLUE CROSS PROVIDER #
FL
01
—
MA29294
MASSAGE THERAPY LICENSE
FL
Enumeration date
04/19/2007
Last updated
08/22/2020
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