=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245944941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKILLS DRIVEN THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2023
-----------------------------------------------------
Last Update Date | 06/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4987 N UNIVERSITY DR # 15B
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-573-1835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4987 N UNIVERSITY DR # 15B
-----------------------------------------------------
City | LAUDERHILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-573-1835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HIRAM AGUILERA
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 954-573-1835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------