MEDICARE: TOADAL CONTROL ABA

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	:	1326732777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOADAL CONTROL ABA

Provider Business Mailing Address
First Line	:	295 NW COMMONS LOOP STE 115-203
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7721
Country	:	US
Telephone Number	:	347-563-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	295 NW COMMONS LOOP STE 115-203
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-7721
Country	:	US
Telephone Number	:	347-563-8288
Fax Number	:

Authorized Official
Title or Position	:	CEO/COO
Name	:	MRS. BRITTANY N MULLER
Credential	:	BCBA
Telephone Number	:	347-563-8288

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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