Healthcare Provider Details

I. General information

NPI: 1184566770
Provider Name (Legal Business Name): OPTIMAL ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1659 SHEPHERD LANE
INTERCESSION CITY FL
33848
US

IV. Provider business mailing address

PO BOX 1091
INTERCESSION CITY FL
33848-1091
US

V. Phone/Fax

Practice location:
  • Phone: 407-561-6542
  • Fax:
Mailing address:
  • Phone: 305-546-5466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE VILLAVICENCIO
Title or Position: OWNER
Credential:
Phone: 407-561-6542