Healthcare Provider Details

I. General information

NPI: 1508428483
Provider Name (Legal Business Name): ABA AND PLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21701 CEDAR ST
SAINT CLAIR SHORES MI
48081-2823
US

IV. Provider business mailing address

21701 CEDAR ST
SAINT CLAIR SHORES MI
48081-2823
US

V. Phone/Fax

Practice location:
  • Phone: 586-872-7282
  • Fax:
Mailing address:
  • Phone: 586-872-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMES NUSE
Title or Position: CO-OWNER
Credential: BCBA
Phone: 586-872-7282