Healthcare Provider Details

I. General information

NPI: 1225572829
Provider Name (Legal Business Name): ALIE MARIE KOTHMAN MS, BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

773 BROOKSEDGE BLVD
WESTERVILLE OH
43081-2821
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 614-401-3366
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.00378
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: