Provider Demographics
NPI:1225572829
Name:KOTHMAN, ALIE MARIE (MS, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:ALIE
Middle Name:MARIE
Last Name:KOTHMAN
Suffix:
Gender:F
Credentials:MS, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:773 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2821
Practice Address - Country:US
Practice Address - Phone:614-401-3366
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00378103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-17-26118OtherBCBA CERTIFICATE