MEDICARE: AZIZULLAH HOTAK MS. ABA, BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0133004368	VA

General Provider Information

NPI Number	:	1477326569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZIZULLAH HOTAK MS. ABA, BCBA, LBA

Provider Business Mailing Address
First Line	:	14123 ROBERT PARIS CT
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-4203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3487 CHRISY LN
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193
Country	:	US
Telephone Number	:	571-412-7994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	06/04/2026

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