MEDICARE: LITTLE ROOTS PEDIATRIC THERAPY

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	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1225820525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE ROOTS PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	4232 S HEATHER PRIVADO
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-2606
Country	:	US
Telephone Number	:	714-272-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	4232 S HEATHER PRIVADO
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-2606
Country	:	US
Telephone Number	:	714-272-5193
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MAUSAMBEN AMIN
Credential	:	MSOT
Telephone Number	:	714-272-5193

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	06/09/2025

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Directions to “LITTLE ROOTS PEDIATRIC THERAPY ” Practice Location

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