MEDICARE: ABA MOMENTUM 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	:	1194585497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA MOMENTUM CORP

Provider Business Mailing Address
First Line	:	5016 MOSS HAMMOCK TRL
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-4414
Country	:	US
Telephone Number	:	786-566-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5016 MOSS HAMMOCK TRL
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-4414
Country	:	US
Telephone Number	:	786-566-3222
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEISY CAMERO
Credential	:
Telephone Number	:	786-566-3222

Provider Enumeration Date	:	03/21/2024
Last Update Date	:	03/21/2024

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Directions to “ABA MOMENTUM CORP ” Practice Location

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