Provider Demographics
NPI:1104697341
Name:LITTLE ROOTS THERAPY, LLC
Entity type:Organization
Organization Name:LITTLE ROOTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COTA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:479-806-2879
Mailing Address - Street 1:2941 N DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-4517
Mailing Address - Country:US
Mailing Address - Phone:479-806-2879
Mailing Address - Fax:
Practice Address - Street 1:2941 N DAVIS ST
Practice Address - Street 2:
Practice Address - City:LAVACA
Practice Address - State:AR
Practice Address - Zip Code:72941-4517
Practice Address - Country:US
Practice Address - Phone:479-806-2879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty