Provider Demographics
NPI:1588480693
Name:TINY BUBBLES SLP LLC
Entity type:Organization
Organization Name:TINY BUBBLES SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ SLP
Authorized Official - Prefix:
Authorized Official - First Name:ELBANGELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:787-245-5379
Mailing Address - Street 1:173 NOBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-8446
Mailing Address - Country:US
Mailing Address - Phone:787-245-5379
Mailing Address - Fax:
Practice Address - Street 1:173 NOBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-8446
Practice Address - Country:US
Practice Address - Phone:787-245-5379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No252Y00000XAgenciesEarly Intervention Provider Agency