Individual
LARRY DON OTWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
317 W CHEROKEE AVE, SUITE B, ENID, OK 73701-5615
(888) 573-7792
(888) 573-7792
Mailing address
2005 W ELM AVE, ENID, OK 73703-4208
(580) 478-7684
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0046123
OK
Other
Enumeration date
04/01/2015
Last updated
04/01/2015
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