Provider Demographics
NPI:1710546833
Name:OTTO, LORINDA (BCBA-D)
Entity type:Individual
Prefix:
First Name:LORINDA
Middle Name:
Last Name:OTTO
Suffix:
Gender:F
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SPENRYN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-1890
Mailing Address - Country:US
Mailing Address - Phone:256-772-4400
Mailing Address - Fax:
Practice Address - Street 1:300 PELHAM AVE SW STE A4
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5117
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:855-832-6727
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18-59791106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician