Doctor Name: | OTHA FOSTER |
NPI Number: | 1598175424 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 009196897 |
Business Practice Address: | 4 Meadows Apt Livingston, AL - 35470 |
Business Phone Number: | 9852411875 |
Business Fax Number: | |
Mailing Address: | 4 Meadows Apt, LIVINGSTON |
State: | AL |
Postal Code: | 35470 |
Phone Number: | 9852411875 |
Fax Number: | |
NPI Enumeration Date: | 04/30/2014 |
NPI Last Update Date: | 04/30/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385H00000X |
License Number: | 009196897 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | |
Taxonomy Definition: |