MEDICARE: ORANGE BRANCH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063240992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE BRANCH THERAPY LLC

Provider Business Mailing Address
First Line	:	148 ROBERTS VILLAGE CT STE 1301
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-9582
Country	:	US
Telephone Number	:	904-701-2112
Fax Number	:	904-789-5759

Provider Business Practice Location Address
First Line	:	148 ROBERTS VILLAGE CT STE 1301
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-9582
Country	:	US
Telephone Number	:	904-701-2112
Fax Number	:	904-789-5759

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARAH PISTNER
Credential	:	BCBA
Telephone Number	:	904-701-2112

Provider Enumeration Date	:	07/23/2024
Last Update Date	:	02/09/2026

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