Healthcare Provider Details

I. General information

NPI: 1427948546
Provider Name (Legal Business Name): COURTNEY BOITANO OTD, OTR/L, BCBA-D, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19474 AERONAUT WAY
LOS GATOS CA
95033-9126
US

IV. Provider business mailing address

19474 AERONAUT WAY
LOS GATOS CA
95033-9126
US

V. Phone/Fax

Practice location:
  • Phone: 310-613-8676
  • Fax:
Mailing address:
  • Phone: 310-613-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: COURTNEY BOITANO
Title or Position: OWNER
Credential: OTD, OTR/L, BCBA-D
Phone: 310-613-8676