Provider Demographics
NPI:1629499272
Name:OTT, JOSEPH (BCBA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:OTT
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 1:76 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-9633
Mailing Address - Country:US
Mailing Address - Phone:610-390-2806
Mailing Address - Fax:
Practice Address - Street 1:76 MAPLE DR
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9633
Practice Address - Country:US
Practice Address - Phone:610-390-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000207103K00000X
1-13-13526103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst