Healthcare Provider Details

I. General information

NPI: 1669388401
Provider Name (Legal Business Name): SQUARE PEGS CONNECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32401-3642
US

IV. Provider business mailing address

619 MARTIN LUTHER KING JR BLVD
PANAMA CITY FL
32401-3642
US

V. Phone/Fax

Practice location:
  • Phone: 850-276-5553
  • Fax: 888-425-0509
Mailing address:
  • Phone: 850-276-5553
  • Fax: 888-425-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA SEATON
Title or Position: EXECUTIVE DIRECTOR
Credential: BCBA
Phone: 850-276-5553