MEDICARE: CHILDHOOD EARLY INTERVENTION, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	2251P0200X	Pediatric Physical Therapist
3	225XP0200X	Pediatric Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336203843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDHOOD EARLY INTERVENTION, LLC

Provider Business Mailing Address
First Line	:	6743 FAIRWAY DR E
Second Line	:
City	:	FAYETTEVILLE
State	:	PA
Zip	:	17222-9400
Country	:	US
Telephone Number	:	717-360-3989
Fax Number	:	717-352-8360

Provider Business Practice Location Address
First Line	:	6743 FAIRWAY DR E
Second Line	:
City	:	FAYETTEVILLE
State	:	PA
Zip	:	17222-9400
Country	:	US
Telephone Number	:	717-360-3989
Fax Number	:	717-352-8360

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. AUDREY LINN LIST
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	717-360-3989

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	09/11/2025

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Directions to “CHILDHOOD EARLY INTERVENTION, LLC ” Practice Location

Language	Start Address	Practice Location

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