Provider Demographics
NPI:1396636676
Name:LITTLE FERN FOREST, LLC
Entity type:Organization
Organization Name:LITTLE FERN FOREST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-903-6572
Mailing Address - Street 1:21059 FERN ST NE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:WA
Mailing Address - Zip Code:98342-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21059 FERN ST NE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:WA
Practice Address - Zip Code:98342-9727
Practice Address - Country:US
Practice Address - Phone:530-903-6572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty