MEDICARE: LITTLE RAINBOW PEDIATRIC THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1063266351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE RAINBOW PEDIATRIC THERAPY, PLLC

Provider Business Mailing Address
First Line	:	6739 W ALEGRIA DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-1006
Country	:	US
Telephone Number	:	520-329-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	6739 W ALEGRIA DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85743-1006
Country	:	US
Telephone Number	:	520-329-3077
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	SYDNEY RADCLIFF
Credential	:	MOT, OTR/L
Telephone Number	:	502-471-8388

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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