MEDICARE: PRESTIGE ABA THERAPY LLC

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	:	1629927413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	525 HIGHLAND BLVD STE 105
Second Line	:
City	:	COATESVILLE
State	:	PA
Zip	:	19320-5810
Country	:	US
Telephone Number	:	347-216-8482
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 HIGHLAND BLVD STE 105
Second Line	:
City	:	COATESVILLE
State	:	PA
Zip	:	19320-5810
Country	:	US
Telephone Number	:	347-216-8482
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/DIRECTOR
Name	:	KADIATOU DIALLO
Credential	:	MS, LBS, BCBA
Telephone Number	:	347-216-8482

Provider Enumeration Date	:	01/24/2026
Last Update Date	:	01/24/2026

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