Individual
REBECCA OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
24321 WILLOW LN, NOVI, MI 48375-2861
(248) 345-2764
Mailing address
24321 WILLOW LN, NOVI, MI 48375-2861
(248) 345-2764
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703046483
MI
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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