MEDICARE: PELICAN OF WELLNESS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386965077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELICAN OF WELLNESS

Provider Business Mailing Address
First Line	:	2701 W OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1388
Country	:	US
Telephone Number	:	954-987-3201
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W OAKLAND PARK BLVD
Second Line	:
City	:	OAKLAND PARK
State	:	FL
Zip	:	33311-1388
Country	:	US
Telephone Number	:	954-987-3201
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	MR. ORVILLE ANTHONY LYTTLE
Credential	:	MASTER
Telephone Number	:	954-987-3201

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	08/20/2023

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Directions to “PELICAN OF WELLNESS ” Practice Location

Language	Start Address	Practice Location

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