MEDICARE: TINY TOTS PEDIATRIC THERAPIES, 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	235Z00000X	Speech-Language Pathologist	146004653	IL

General Provider Information

NPI Number	:	1861668998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY TOTS PEDIATRIC THERAPIES, INC

Provider Business Mailing Address
First Line	:	1900 S VINE AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-5324
Country	:	US
Telephone Number	:	847-281-6993
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 VINE AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-5324
Country	:	US
Telephone Number	:	847-281-6993
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KELLY CREES
Credential	:	MA, CCC-SLP
Telephone Number	:	847-281-6993

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	03/25/2026

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