Healthcare Provider Details

I. General information

NPI: 1356261960
Provider Name (Legal Business Name): LITTLE WAVES ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 DEER LAKE CIR
ORMOND BEACH FL
32174-4275
US

IV. Provider business mailing address

134 DEER LAKE CIR
ORMOND BEACH FL
32174-4275
US

V. Phone/Fax

Practice location:
  • Phone: 774-243-4145
  • Fax:
Mailing address:
  • Phone: 774-243-4145
  • 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: RIAN KUBANNEK
Title or Position: CEO/ LEAD ANALYST
Credential: MS, BCBA
Phone: 774-243-4145