MEDICARE: ONE BY ONE - ABA & RELATED SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician	NV
2	225X00000X	Occupational Therapist
3	103K00000X	Behavior Analyst	NV

General Provider Information

NPI Number	:	1497257885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE BY ONE - ABA & RELATED SERVICES

Provider Business Mailing Address
First Line	:	2301 CEDAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 CEDAR AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3401
Country	:	US
Telephone Number	:	702-534-9563
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AGUSTIN PENA
Credential	:
Telephone Number	:	702-534-9563

Provider Enumeration Date	:	03/01/2018
Last Update Date	:	03/02/2018

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