Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1073051447 |
---|---|
Provider Name | Pablo Otalvaro |
First Address | Clearwater, FL 33760-1367 |
Second Address | Clearwater, FL 33760-1367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 22/09/2017 |