Healthcare Provider Details

I. General information

NPI: 1255930905
Provider Name (Legal Business Name): FATIMA ALKASSIR OTHMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FATIMA ALKASSIR

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39555 ORCHARD HILL PL STE 600
NOVI MI
48375-5381
US

IV. Provider business mailing address

18726 S WESTERN AVE
GARDENA CA
90248-3813
US

V. Phone/Fax

Practice location:
  • Phone: 248-599-1582
  • Fax: 855-568-2494
Mailing address:
  • Phone: 310-856-0800
  • Fax: 855-568-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001215
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: