Healthcare Provider Details

I. General information

NPI: 1104417005
Provider Name (Legal Business Name): TINY WONDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16607 RIVERSTONE WAY STE 200
CHARLOTTE NC
28277-5750
US

IV. Provider business mailing address

16607 RIVERSTONE WAY STE 200
CHARLOTTE NC
28277-5750
US

V. Phone/Fax

Practice location:
  • Phone: 980-250-1505
  • Fax:
Mailing address:
  • Phone: 980-250-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY M GRIFFIN
Title or Position: OWNER, CERTIFIED ORTHOTIST
Credential: CO
Phone: 980-250-1505