Provider Demographics
NPI:1508636655
Name:OTTO, ROBERT WILLIAM (RBT, MA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:OTTO
Suffix:
Gender:M
Credentials:RBT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WINCHESTER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1163
Mailing Address - Country:US
Mailing Address - Phone:408-824-9355
Mailing Address - Fax:
Practice Address - Street 1:1700 WINCHESTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1163
Practice Address - Country:US
Practice Address - Phone:408-824-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician