Healthcare Provider Details

I. General information

NPI: 1720970106
Provider Name (Legal Business Name): TINY TIDES PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 BAKERS XING
SAVANNAH GA
31406-5160
US

IV. Provider business mailing address

8 BAKERS XING
SAVANNAH GA
31406-5160
US

V. Phone/Fax

Practice location:
  • Phone: 912-659-1246
  • Fax:
Mailing address:
  • Phone: 912-659-1246
  • Fax: 912-250-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. REED THOMAS CETTI
Title or Position: OWNER
Credential: OTR/L
Phone: 912-659-1246