Healthcare Provider Details

I. General information

NPI: 1225643935
Provider Name (Legal Business Name): TINY HANDS THERAPEUTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 TERRY ST
RACELAND KY
41169-1906
US

IV. Provider business mailing address

1131 TERRY ST
RACELAND KY
41169-1906
US

V. Phone/Fax

Practice location:
  • Phone: 606-939-4673
  • Fax:
Mailing address:
  • Phone: 606-939-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ADA LAWSON
Title or Position: MANAGER
Credential: OTR/L
Phone: 606-939-4673