=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285370585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LITTLE PINES PEDIATRIC THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 03/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 DICKENSON LN
-----------------------------------------------------
City | PAIGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78659-4967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-292-1394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 DICKENSON LN
-----------------------------------------------------
City | PAIGE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78659-4967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-292-1394
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | SHANNON EIZEMBER
-----------------------------------------------------
Credential | OTR/MOT
-----------------------------------------------------
Telephone | 956-292-1394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------