=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720889678
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN WOLLEY MS, BCBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2025
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 254 N BROADWAY UNIT 112
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03079-2132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-515-8947
-----------------------------------------------------
Fax | 561-335-5182
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ABA CENTERS OF AMERICA 4620 N STATE RD 7, STE 300
-----------------------------------------------------
City | LAUDERDALE LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33319-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-323-6593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------