MEDICARE: DR. MARY ANNETTE LITTLE PHD, BCBA

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	222Q00000X	Developmental Therapist	1062814	TN
2	103K00000X	Behavior Analyst	1-06-2814	TN

General Provider Information

NPI Number	:	1275789380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANNETTE LITTLE PHD, BCBA

Provider Business Mailing Address
First Line	:	2006 ADAMS RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-6323
Country	:	US
Telephone Number	:	615-504-2777
Fax Number	:	615-460-5556

Provider Business Practice Location Address
First Line	:	2006 ADAMS RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-6323
Country	:	US
Telephone Number	:	615-504-2777
Fax Number	:	615-460-5556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	04/24/2012

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