Healthcare Provider Details

I. General information

NPI: 1629774419
Provider Name (Legal Business Name): POWER KIDZ ABA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14880 SW 155TH TER
MIAMI FL
33187-5564
US

IV. Provider business mailing address

14880 SW 155TH TER
MIAMI FL
33187-5564
US

V. Phone/Fax

Practice location:
  • Phone: 305-632-6393
  • Fax:
Mailing address:
  • Phone:
  • 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: JESSICA NOVOA
Title or Position: OWNER
Credential:
Phone: 786-334-8099