Provider Demographics
NPI:1316728314
Name:DODOO, OTELIA
Entity type:Individual
Prefix:
First Name:OTELIA
Middle Name:
Last Name:DODOO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 KINGS HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5319
Mailing Address - Country:US
Mailing Address - Phone:860-992-9882
Mailing Address - Fax:
Practice Address - Street 1:248 BRIDGEPORT AVE STE 44A
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4146
Practice Address - Country:US
Practice Address - Phone:860-992-9882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-06
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier