Provider Demographics
NPI:1700626074
Name:OTTO MATIC PARTNERS GOOSE CREEK
Entity type:Organization
Organization Name:OTTO MATIC PARTNERS GOOSE CREEK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-991-5165
Mailing Address - Street 1:214 SAINT JAMES AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3082
Mailing Address - Country:US
Mailing Address - Phone:843-991-5165
Mailing Address - Fax:
Practice Address - Street 1:214 SAINT JAMES AVE STE 150
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3082
Practice Address - Country:US
Practice Address - Phone:843-991-5165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IM PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty