Individual
OTIE WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22376 W 12 MILE RD, SOUTHFIELD, MI 48034-4675
(313) 522-2062
Mailing address
22376 W 12 MILE RD, SOUTHFIELD, MI 48034-4675
(313) 522-2062
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
MI
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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