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General NPI Number Information
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NPI Number | 1285590208
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Entity Type | Individual
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Provider Name | NOEL OTETO P.H.D., BCBA-D
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Gender | Male
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Dates
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Enumeration Date | 01/03/2026
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Last Update Date | 01/03/2026
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Provider Practice Location Address
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Address Line | 600 3 MILE RD NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49544-1685
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Country | US
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Telephone | 616-469-3870
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Fax |
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Provider Business Mailing Address
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Address Line | 16343 TRENT RIDGE DR
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City | CEDAR SPRINGS
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State | MI
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Zip | 49319-9665
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Country | US
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Telephone | 616-264-9912
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401003065
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License Number State | MI
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