MEDICARE: ABA COOP

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518523745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA COOP

Provider Business Mailing Address
First Line	:	PO BOX 2164
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-2164
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 S FRETZ AVE STE D
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73003-5570
Country	:	US
Telephone Number	:	405-202-6510
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JEREMY MALWICK
Credential	:	BCBA
Telephone Number	:	405-202-6510

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	01/15/2026

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