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General NPI Number Information
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NPI Number | 1699251793
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Entity Type | Organization
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Legal Business Name | BIG WHEEL ABA LLC.
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 07/12/2018
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Provider Practice Location Address
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Address Line | 8175 SARCEE TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5424
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Country | US
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Telephone | 505-819-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 8175 SARCEE TRL
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City | JACKSONVILLE
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State | FL
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Zip | 32244-5424
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Country | US
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Telephone | 505-819-7505
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. BRYANT WAYNE RAGSDALE
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Credential | BCBA 1-16-22908
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Telephone | 505-819-7505
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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 | 1-16-22908
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License Number State |
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