Healthcare Provider Details

I. General information

NPI: 1356659536
Provider Name (Legal Business Name): LITTLE STAR THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15485 EAGLE NEST LN STE 220
MIAMI LAKES FL
33014-2222
US

IV. Provider business mailing address

6840 SW 14TH ST
MIAMI FL
33144-5531
US

V. Phone/Fax

Practice location:
  • Phone: 786-477-5783
  • Fax:
Mailing address:
  • Phone: 305-458-8688
  • Fax: 305-458-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIE KATRINA MARTINEZ
Title or Position: OWNER
Credential:
Phone: 305-458-8688