Individual
ALICIA KOKOMOOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
919 S CENTRAL AVE, FAIRBORN, OH 45324-3804
(937) 878-4614
Mailing address
2358 MURPHY DR, FAIRBORN, OH 45324-2172
(419) 819-7586
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB630845
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB630845
REGISTERED BEHAVIOR TECHNICIAN
OH
Enumeration date
04/26/2021
Last updated
04/26/2021
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