Healthcare Provider Details

I. General information

NPI: 1285590208
Provider Name (Legal Business Name): NOEL OTETO P.H.D., BCBA-D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 3 MILE RD NW SUITE 200
GRAND RAPIDS MI
49544-1691
US

IV. Provider business mailing address

16343 TRENT RIDGE DR
CEDAR SPRINGS MI
49319-9665
US

V. Phone/Fax

Practice location:
  • Phone: 616-469-3870
  • Fax:
Mailing address:
  • Phone: 616-264-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: