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General NPI Number Information
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NPI Number | 1508268202
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Entity Type | Organization
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Legal Business Name | KOABA KIDS, LLC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 4924 ANTONINI DR
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City | METAIRIE
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State | LA
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Zip | 70006-2144
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Country | US
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Telephone | 443-535-3819
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Fax |
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Provider Business Mailing Address
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Address Line | 4924 ANTONINI DR
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City | METAIRIE
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State | LA
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Zip | 70006-2144
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Country | US
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Telephone | 443-535-3819
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | JENNIFER ROSE PLA
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Credential | M.ED., BCBA, LBA
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Telephone | 443-535-3819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L-061
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License Number State | LA
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