Provider Demographics
NPI:1023739984
Name:OTEY, DARRELL AMOS
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:AMOS
Last Name:OTEY
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 1:109 THORN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3571
Mailing Address - Country:US
Mailing Address - Phone:304-425-3222
Mailing Address - Fax:304-431-2450
Practice Address - Street 1:109 THORN ST STE C
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3571
Practice Address - Country:US
Practice Address - Phone:304-425-3222
Practice Address - Fax:304-431-2450
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant