Active NPI
Justin Daniel Otterson
- Behavior Technician
- Concord, CA
National Provider Identifier
1417693433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1200 Concord Ave Ste 100
Concord, CA 94520-4969 - Phone
- (510) 268-8120
- NPI assigned
- May 11, 2022
- Sex
- Male
- 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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
1200 Concord Ave Ste 100
Concord, CA 94520-4969
Mailing address
1025 Atlantic Ave Ste 101
Alameda, CA 94501-1188
Other practice location 1
210 King Dr
Walnut Creek, CA 94595-1505
Phone (919) 412-6489
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": "1652227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1417693433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 ATLANTIC AVE STE 101",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945011188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CONCORD AVE STE 100",
"city": "CONCORD",
"state": "CA",
"postal_code": "945204969",
"telephone_number": "510-268-8120"
}
],
"practiceLocations": [
{
"address_1": "210 King Dr",
"address_purpose": "LOCATION",
"city": "Walnut Creek",
"state": "CA",
"postal_code": "945951505",
"country_code": "US",
"telephone_number": "919-412-6489",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OTTERSON",
"first_name": "JUSTIN",
"middle_name": "DANIEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-11",
"last_updated": "2022-05-12",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.