Healthcare Provider Details

I. General information

NPI: 1841177094
Provider Name (Legal Business Name): LITTLE LEADERS THERAPIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 ROBERTS BLVD NW STE 122
KENNESAW GA
30144-3694
US

IV. Provider business mailing address

8767 HEADLEY DR
STERLING HEIGHTS MI
48314-2661
US

V. Phone/Fax

Practice location:
  • Phone: 954-932-5958
  • Fax:
Mailing address:
  • Phone: 954-932-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARIE BAUTISTA
Title or Position: OWNER
Credential:
Phone: 954-932-5958