Provider Demographics
NPI:1386474633
Name:OMOT, OJEM PETER
Entity type:Individual
Prefix:
First Name:OJEM
Middle Name:PETER
Last Name:OMOT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 CLEARWATER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6190
Mailing Address - Country:US
Mailing Address - Phone:320-237-6571
Mailing Address - Fax:
Practice Address - Street 1:2907 CLEARWATER RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6190
Practice Address - Country:US
Practice Address - Phone:320-237-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist