MEDICARE: MAKING STRIDES ABA THERAPY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114378445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAKING STRIDES ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	4651 BABCOCK ST NE
Second Line	:	STE 18
City	:	PALM BAY
State	:	FL
Zip	:	32905-2844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4651 BABCOCK ST NE
Second Line	:	STE 18
City	:	PALM BAY
State	:	FL
Zip	:	32905-2844
Country	:	US
Telephone Number	:	321-338-3936
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	KIARA SANTIAGO
Credential	:	BCBA
Telephone Number	:	516-547-5024

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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