Healthcare Provider Details

I. General information

NPI: 1639680671
Provider Name (Legal Business Name): ROYLEANE ELIZABETH OTTESON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 236TH AVE NE
REDMOND WA
98053-1982
US

IV. Provider business mailing address

8906 236TH AVE NE
REDMOND WA
98053-1982
US

V. Phone/Fax

Practice location:
  • Phone: 425-202-7187
  • Fax:
Mailing address:
  • Phone: 425-202-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-38139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: