=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225643935
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TINY HANDS THERAPEUTICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2020
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1131 TERRY ST
-----------------------------------------------------
City | RACELAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41169-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-939-4673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1131 TERRY ST
-----------------------------------------------------
City | RACELAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41169-1906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-939-4673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | ADA LAWSON
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 606-939-4673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------