Healthcare Provider Details

I. General information

NPI: 1548871791
Provider Name (Legal Business Name): ABA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44225 W 12 MILE RD STE C-106
NOVI MI
48377-2640
US

IV. Provider business mailing address

44225 W 12 MILE RD STE C-106
NOVI MI
48377-2640
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax: 248-277-3050
Mailing address:
  • Phone: 248-277-3005
  • Fax: 248-277-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMY COLLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-277-3005