Healthcare Provider Details

I. General information

NPI: 1184018731
Provider Name (Legal Business Name): SMALL STEPS PEDIATRIC SPEECH THERAPY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5877 HWY 21 S
RINCON GA
31326-5511
US

IV. Provider business mailing address

PO BOX 1220
RINCON GA
31326-1220
US

V. Phone/Fax

Practice location:
  • Phone: 912-330-6127
  • Fax: 912-335-3848
Mailing address:
  • Phone: 912-667-1614
  • Fax: 912-335-3848

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 TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberSLP008055
License Number StateGA

VIII. Authorized Official

Name: AMANDA DANIELLE LONG
Title or Position: OWNER/SLP
Credential: M.ED, CCC-SLP
Phone: 912-667-1614