Healthcare Provider Details

I. General information

NPI: 1124732912
Provider Name (Legal Business Name): LITTLE HANDS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20514 AMBROSIA LN
BEND OR
97702-9332
US

IV. Provider business mailing address

PO BOX 722
BEND OR
97709-0722
US

V. Phone/Fax

Practice location:
  • Phone: 541-576-8318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1922643675
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer

VIII. Authorized Official

Name: ALYSSA SNOW
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: MOT, OTR/L
Phone: 541-390-1805