Healthcare Provider Details

I. General information

NPI: 1912662115
Provider Name (Legal Business Name): PUZZLY ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1166 PALM SPRINGS CT
PORT ORANGE FL
32128-6947
US

IV. Provider business mailing address

1166 PALM SPRINGS CT
PORT ORANGE FL
32128-6947
US

V. Phone/Fax

Practice location:
  • Phone: 407-613-4272
  • Fax:
Mailing address:
  • Phone: 407-613-4272
  • 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: VICTORIA GAUTHIER
Title or Position: OWNER
Credential: BCBA
Phone: 407-613-4272