MEDICARE: LITTLE CHICK LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1609452325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE CHICK LLC

Provider Business Mailing Address
First Line	:	3001 PEMBROOK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-2254
Country	:	US
Telephone Number	:	407-314-1802
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 PEMBROOK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-2254
Country	:	US
Telephone Number	:	407-314-1802
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DEVIN JAE WILBER
Credential	:
Telephone Number	:	407-314-1802

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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Directions to “LITTLE CHICK LLC ” Practice Location

Language	Start Address	Practice Location

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