=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215808951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINY TRIUMPHS PEDIATRIC THERAPY , LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4011 COTTONWOOD DR
-----------------------------------------------------
City | BOONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47601-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-629-6030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4011 COTTONWOOD DR
-----------------------------------------------------
City | BOONVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47601-0038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-629-6030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. AMY HAYHURST
-----------------------------------------------------
Credential | MS, CCC- SLP
-----------------------------------------------------
Telephone | 812-629-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------