Provider Demographics
NPI:1093172462
Name:FIRE FLY AUTISM
Entity Type:Organization
Organization Name:FIRE FLY AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELA
Authorized Official - Middle Name:ORSOGNA
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:508-455-7848
Mailing Address - Street 1:1332 6TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5801
Mailing Address - Country:US
Mailing Address - Phone:508-455-7848
Mailing Address - Fax:
Practice Address - Street 1:1332 6TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5801
Practice Address - Country:US
Practice Address - Phone:508-455-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-15-18951305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization