Active NPI
Christine Marie Otersen
- Behavior Analyst
- Acworth, GA
National Provider Identifier
1265819965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3662 Cedarcrest Rd Ste 220
Acworth, GA 30101-8765 - Phone
- (470) 531-0512
- NPI assigned
- May 1, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
3662 Cedarcrest Rd Ste 220
Acworth, GA 30101-8765
Mailing address
300 International Pkwy Ste 200
Lake Mary, FL 32746-5028
Phone (678) 978-5585
Other practice location 1
53 Perimeter Ctr E Ste 350
Atlanta, GA 30346-2204
Phone (866) 750-5554
Other practice location 2
535 Riverstone Pkwy Ste 101
Canton, GA 30114-2566
Phone (470) 863-3092
Other practice location 3
1215 Hightower Trail Bldg. B, Suite 120
Atlanta, GA 30350
Phone (678) 978-5585
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265819965 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1430438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580428800000",
"number": "1265819965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PKWY STE 200",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327465028",
"telephone_number": "678-978-5585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3662 CEDARCREST RD STE 220",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301018765",
"telephone_number": "470-531-0512"
}
],
"practiceLocations": [
{
"address_1": "53 Perimeter Ctr E Ste 350",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "303462204",
"country_code": "US",
"telephone_number": "866-750-5554",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "535 Riverstone Pkwy Ste 101",
"address_purpose": "LOCATION",
"city": "Canton",
"state": "GA",
"postal_code": "301142566",
"country_code": "US",
"telephone_number": "470-863-3092",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1215 Hightower Trail Bldg. B, Suite 120",
"address_purpose": "LOCATION",
"city": "Atlanta",
"state": "GA",
"postal_code": "30350",
"country_code": "US",
"telephone_number": "678-978-5585",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OTERSEN",
"first_name": "CHRISTINE",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-01",
"last_updated": "2020-01-31",
"certification_date": "2020-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265819965",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.