MEDICARE: EARLY BIRD INTERVENTION, LLP

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1780569632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY BIRD INTERVENTION, LLP

Provider Business Mailing Address
First Line	:	1261 WILD GOOSE TRL
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-8023
Country	:	US
Telephone Number	:	843-906-1458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1261 WILD GOOSE TRL
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-8023
Country	:	US
Telephone Number	:	843-906-1458
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	ALYSSA ANDRACCHIO
Credential	:
Telephone Number	:	843-906-1458

Provider Enumeration Date	:	08/09/2025
Last Update Date	:	03/03/2026

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