Individual
JAVIER OTALORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1670 JAMES ST, NORTH MERRICK, NY 11566-1970
(718) 864-6927
Mailing address
1670 JAMES ST, NORTH MERRICK, NY 11566-1970
(718) 864-6927
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/26/2017
Last updated
07/26/2017
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