MEDICARE: WILLOW PATH ABA & LEARNING LC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1184598518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW PATH ABA & LEARNING LC

Provider Business Mailing Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:	PMB1014
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	626 N ALAFAYA TRL STE 206
Second Line	:	PMB1014
City	:	ORLANDO
State	:	FL
Zip	:	32828-4353
Country	:	US
Telephone Number	:	689-326-7019
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ BEHAVIOR ANALYST
Name	:	TIFFANY MEDINA
Credential	:	M.A, BCBA/LBA
Telephone Number	:	689-326-7019

Provider Enumeration Date	:	09/30/2025
Last Update Date	:	10/06/2025

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