Basic Information
| Provider Information | |||||||||
| NPI: | 1386829208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTEY | ||||||||
| FirstName: | ASIM | ||||||||
| MiddleName: | SALIH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 616 FM 1960 W | ||||||||
| Address2: | 230 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8777497428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1100 BLYTHE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045124808 | ||||||||
| FaxNumber: | 7045124838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 238535 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 2008-00366 | NC | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1386829208 | 05 | NC | MEDICAID | 5909721 | 05 | NC | MEDICAID | N66008 | 05 | SC | MEDICAID |