MEDICARE: LITTLE WAVES THERAPY, LLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1518793918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE WAVES THERAPY, LLC

Provider Business Mailing Address
First Line	:	576 N BIRDNECK RD # 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6374
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	576 N BIRDNECK RD # 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6374
Country	:	US
Telephone Number	:	410-458-8934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BROOKE ODLAND
Credential	:	CCC-SLP
Telephone Number	:	410-458-8934

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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Directions to “LITTLE WAVES THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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