=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295648657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1213 S CHAMPION AVE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2026
-----------------------------------------------------
Last Update Date | 09/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 E 1ST AVE STE 102
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43201-3792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-216-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 46 KNIGHTS BRIDGE DR W
-----------------------------------------------------
City | PICKERINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43147-8181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-216-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AARON BRANDON DAVENPORT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-216-1388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------