Provider Demographics
NPI:1639717994
Name:KAPOOR, OLGA VLADIMIROVNA (RBT)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:VLADIMIROVNA
Last Name:KAPOOR
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 1:545 DELANEY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3866
Mailing Address - Country:US
Mailing Address - Phone:321-247-5165
Mailing Address - Fax:
Practice Address - Street 1:545 DELANEY AVE STE 5
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3866
Practice Address - Country:US
Practice Address - Phone:321-247-5165
Practice Address - Fax:208-693-4755
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-103173106S00000X
FL1-21-48611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician