MEDICARE: LITTLE STAR THERAPY SERVICES, INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1548939416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE STAR THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	15485 EAGLE NEST LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2247
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15485 EAGLE NEST LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2247
Country	:	US
Telephone Number	:	305-458-8688
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NATALIE KATRINA MARTINEZ
Credential	:
Telephone Number	:	305-458-8688

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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