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General NPI Number Information
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NPI Number | 1568973147
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Entity Type | Organization
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Legal Business Name | APPLIED BEHAVIOR ANALYSIS SPORTS INNOVATIONS LLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 2907 CYPRESS BOWL RD
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City | LUTZ
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State | FL
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Zip | 33558-5040
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Country | US
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Telephone | 813-786-0551
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 CYPRESS BOWL RD
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City | LUTZ
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State | FL
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Zip | 33558-5040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALLORY JOANNE QUINN
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Credential | PH.D., BCBA
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Telephone | 813-786-0551
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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 |
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License Number State |
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