Provider Demographics
NPI:1639680671
Name:OTTESON, ROYLEANE ELIZABETH (RBT)
Entity Type:Individual
Prefix:
First Name:ROYLEANE
Middle Name:ELIZABETH
Last Name:OTTESON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 236TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-1982
Mailing Address - Country:US
Mailing Address - Phone:425-202-7187
Mailing Address - Fax:
Practice Address - Street 1:8906 236TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-1982
Practice Address - Country:US
Practice Address - Phone:425-202-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-17-38139106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
BACB387802OtherWHATEVER INSURANCE MY EMPLOYER IS BILLING