Individual
MR. MICHAEL THOMAS OTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
595 ROUND ROCK WEST DR STE 104, ROUND ROCK, TX 78681
(512) 898-9483
Mailing address
595 ROUND ROCK WEST DR STE 104, ROUND ROCK, TX 78681-5028
(512) 898-9483
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-17-27192
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871059675
NPI-2
—
Enumeration date
09/27/2017
Last updated
03/28/2019
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