MEDICARE: TINY TOTS THERAPY

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	41YS00847000	NJ

General Provider Information

NPI Number	:	1902358781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY TOTS THERAPY

Provider Business Mailing Address
First Line	:	551 PARK AVE STE 4
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	551 PARK AVE STE 4
Second Line	:
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1768
Country	:	US
Telephone Number	:	908-380-7715
Fax Number	:

Authorized Official
Title or Position	:	M.A. CCC-SLP
Name	:	MRS. JESSICA BOLLINGER
Credential	:
Telephone Number	:	908-380-7715

Provider Enumeration Date	:	10/27/2016
Last Update Date	:	10/27/2016

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Directions to “TINY TOTS THERAPY ” Practice Location

Language	Start Address	Practice Location

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