Basic Information
| Provider Information | |||||||||
| NPI: | 1417620766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOTRING | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53-980 KAMEHAMEHA HWY | ||||||||
| Address2: | |||||||||
| City: | HAUULA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967179651 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 KAMOKILA BLVD STE 206 | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967072096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085916060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2021 | ||||||||
| LastUpdateDate: | 07/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | RBT-21-170283 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.