Provider Demographics
NPI:1073051447
Name:OTALVARO, PABLO (BCBA)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:OTALVARO
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 COVE CAY DR
Mailing Address - Street 2:UNIT 102
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-1367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2617 COVE CAY DR
Practice Address - Street 2:UNIT 102
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-1367
Practice Address - Country:US
Practice Address - Phone:727-239-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst