Healthcare Provider Details

I. General information

NPI: 1346949807
Provider Name (Legal Business Name): OJOMA OKOTIE BROTHERS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N NELLIS BLVD STE 6
LAS VEGAS NV
89110-5390
US

IV. Provider business mailing address

320 N NELLIS BLVD STE 6
LAS VEGAS NV
89110-5390
US

V. Phone/Fax

Practice location:
  • Phone: 702-525-7918
  • Fax:
Mailing address:
  • Phone: 702-525-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: