Individual
BILLY OTIENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2235 MONTEGO DR, CORDOVA, TN 38016-4558
(901) 238-5792
Mailing address
2235 MONTEGO DR, CORDOVA, TN 38016-4558
(901) 238-5792
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
1344412330
TN
Other
Enumeration date
06/08/2024
Last updated
06/08/2024
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