Healthcare Provider Details

I. General information

NPI: 1376213579
Provider Name (Legal Business Name): NAOMI FATIMA OTHMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2021
Last Update Date: 09/18/2021
Certification Date: 09/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10468 INVESTORS PLACE SUITE B
SPOTSYLVANIA VA
22553-1749
US

IV. Provider business mailing address

10468 INVESTORS PLACE SUITE B
SPOTSYLVANIA VA
22553-1749
US

V. Phone/Fax

Practice location:
  • Phone: 757-384-3248
  • Fax: 540-301-8315
Mailing address:
  • Phone: 757-384-3248
  • Fax: 540-301-8315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-183742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: