Healthcare Provider Details

I. General information

NPI: 1669841136
Provider Name (Legal Business Name): LITTLE FOOT REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 EAST DR PH
NORTH BAY VILLAGE FL
33141-3310
US

IV. Provider business mailing address

1966 NE 123RD ST #220
NORTH MIAMI FL
33181-2868
US

V. Phone/Fax

Practice location:
  • Phone: 305-321-6081
  • Fax:
Mailing address:
  • Phone: 786-316-5118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT10808
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT10808
License Number StateFL

VIII. Authorized Official

Name: TANIA SOMOANO
Title or Position: PRESIDENT
Credential: OT
Phone: 786-316-5118