MEDICARE: OWNLIGHTS ABA SERVICES CORP

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	:	1114640265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWNLIGHTS ABA SERVICES CORP

Provider Business Mailing Address
First Line	:	1221 SW 20TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3202
Country	:	US
Telephone Number	:	786-403-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 SW 20TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3202
Country	:	US
Telephone Number	:	786-403-4105
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISET RODRIGUEZ MARRERO
Credential	:	BCBA
Telephone Number	:	786-403-4105

Provider Enumeration Date	:	09/23/2022
Last Update Date	:	08/01/2023

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Directions to “OWNLIGHTS ABA SERVICES CORP ” Practice Location

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