Provider Demographics
NPI:1487297909
Name:THOTTAM, MARIEL A (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MARIEL
Middle Name:A
Last Name:THOTTAM
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 M ST NE APT 840
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5187
Mailing Address - Country:US
Mailing Address - Phone:330-417-7434
Mailing Address - Fax:
Practice Address - Street 1:9727 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1458
Practice Address - Country:US
Practice Address - Phone:202-420-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA