Provider Demographics
NPI:1205398864
Name:TINY FEET EARLY INTERVENTION
Entity Type:Organization
Organization Name:TINY FEET EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-907-3716
Mailing Address - Street 1:815 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-3002
Mailing Address - Country:US
Mailing Address - Phone:864-907-3716
Mailing Address - Fax:
Practice Address - Street 1:815 BROOKS RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-3002
Practice Address - Country:US
Practice Address - Phone:864-907-3716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency