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MAGDALENA GRACE OTAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2500 POCOSHOCK PL STE 102, NORTH CHESTERFIELD, VA 23235-6345
(804) 562-8705
Mailing address
2500 POCOSHOCK PL STE 102, NORTH CHESTERFIELD, VA 23235-6345
(804) 562-8705

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133005142
VA
106E00000X
Assistant Behavior Analyst
Primary
0134000634
VA

Other

Enumeration date
03/01/2024
Last updated
04/17/2026
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