Provider Demographics
NPI:1871107359
Name:HOMEGROWN PEDIATRIC THERAPY, LLC
Entity type:Organization
Organization Name:HOMEGROWN PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-215-6520
Mailing Address - Street 1:242 CUMBERLAND MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:SUNBRIGHT
Mailing Address - State:TN
Mailing Address - Zip Code:37872-2810
Mailing Address - Country:US
Mailing Address - Phone:423-215-6520
Mailing Address - Fax:
Practice Address - Street 1:116 CUMBERLAND ST.
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-3788
Practice Address - Country:US
Practice Address - Phone:423-215-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty