=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811621410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE LIGHTS ABA THERAPY OF CENTRAL FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2022
-----------------------------------------------------
Last Update Date | 07/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3107 EDGEWATER DR STE 1
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-369-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3107 EDGEWATER DR STE 1
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32804-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DENISE THOMPSON-SHEARER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-946-1930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------