Individual
OTHA FOSTER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4 MEADOWS APT, LIVINGSTON, AL 35470
(985) 241-1875
Mailing address
4 MEADOWS APT, LIVINGSTON, AL 35470
(985) 241-1875
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
009196897
LA
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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