Provider Demographics
NPI:1821743279
Name:OSSIO, FABIOLA (RBT)
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:OSSIO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:FABIOLA
Other - Middle Name:
Other - Last Name:OSSIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:1827 GRAYLAND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5846
Mailing Address - Country:US
Mailing Address - Phone:571-277-1925
Mailing Address - Fax:
Practice Address - Street 1:1320 PLANTATION RD NE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-5713
Practice Address - Country:US
Practice Address - Phone:790-266-7903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-22-203711106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician