Provider Demographics
NPI:1922841766
Name:SMALL, OTASHA SHEMIKA
Entity type:Individual
Prefix:
First Name:OTASHA
Middle Name:SHEMIKA
Last Name:SMALL
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 1:9039 NW 20TH MNR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6138
Mailing Address - Country:US
Mailing Address - Phone:954-344-0063
Mailing Address - Fax:754-229-8852
Practice Address - Street 1:9039 NW 20TH MNR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6138
Practice Address - Country:US
Practice Address - Phone:954-344-0063
Practice Address - Fax:754-229-8852
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator