Provider Demographics
NPI:1225820525
Name:TINY ROOTS PEDIATRIC THEAPY
Entity type:Organization
Organization Name:TINY ROOTS PEDIATRIC THEAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MAUSAMBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT
Authorized Official - Phone:714-272-5193
Mailing Address - Street 1:4232 S HEATHER PRIVADO
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2606
Mailing Address - Country:US
Mailing Address - Phone:714-272-5193
Mailing Address - Fax:
Practice Address - Street 1:4232 S HEATHER PRIVADO
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2606
Practice Address - Country:US
Practice Address - Phone:714-272-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty