MEDICARE: UNIQUE NICHE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1124761531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUE NICHE LLC

Provider Business Mailing Address
First Line	:	515 BELLISSIMO PL
Second Line	:
City	:	HOWEY IN THE HILLS
State	:	FL
Zip	:	34737-0020
Country	:	US
Telephone Number	:	407-640-0845
Fax Number	:

Provider Business Practice Location Address
First Line	:	33741 S HAINES CREEK RD
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-4325
Country	:	US
Telephone Number	:	352-460-1803
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LATHRICIA FRAZIER
Credential	:
Telephone Number	:	407-640-0845

Provider Enumeration Date	:	04/14/2022
Last Update Date	:	04/14/2022

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Directions to “UNIQUE NICHE LLC ” Practice Location

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