MEDICARE: FLORIDA AUTISM CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1578043451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA AUTISM CENTER

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	470-816-6449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 UPPER HEMBREE RD STE D
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-4611
Country	:	US
Telephone Number	:	866-610-0580
Fax Number	:	407-588-6294

Authorized Official
Title or Position	:	CEO
Name	:	JASON OWEN
Credential	:
Telephone Number	:	470-816-6449

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	11/10/2022

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