Provider Demographics
NPI:1962260174
Name:OTASOWIE, TESSY
Entity type:Individual
Prefix:
First Name:TESSY
Middle Name:
Last Name:OTASOWIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7744 ASTRA CIR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9760
Mailing Address - Country:US
Mailing Address - Phone:614-316-1109
Mailing Address - Fax:
Practice Address - Street 1:7744 ASTRA CIR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9760
Practice Address - Country:US
Practice Address - Phone:614-316-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health