Childhood Early Intervention, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

CHILDHOOD EARLY INTERVENTION, LLC

Practice address

6743 Fairway Dr E
Fayetteville, PA 17222-9400

Phone

(717) 360-3989

Fax

(717) 352-8360

NPI assigned

Dec 20, 2006

Last updated

Sep 11, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Audrey Linn List, PHYSICAL THERAPISTNPI 1508908260

Title

Chief Executive Officer

Phone

(717) 360-3989

Specialties & licenses 5

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Audrey Linn List, PT

  • Physical Therapist
  • Fayetteville, PA
  • NPI 1508908260
  NPD (past) Authorized official
• Jill Cooke

  • Speech-Language Pathologist
  • Fayetteville, PA
  • NPI 1083874994
  NPD (past)
• Corinne Killian

  • Speech-Language Pathologist
  • Chambersburg, PA
  • NPI 1417106212
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1336203843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6743 FAIRWAY DR E",
            "city": "FAYETTEVILLE",
            "state": "PA",
            "postal_code": "172229400",
            "telephone_number": "717-360-3989",
            "fax_number": "717-352-8360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6743 FAIRWAY DR E",
            "city": "FAYETTEVILLE",
            "state": "PA",
            "postal_code": "172229400",
            "telephone_number": "717-360-3989",
            "fax_number": "717-352-8360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDHOOD EARLY INTERVENTION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "LIST",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "LINN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "717-360-3989",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1016437230001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• George Augustine Blewitt Sr., M.D.
• Dorothy Boyce, MT-BC, CADC
• Shirley Marie Broadwater, M.S.
• Kla J Brosius, CRNP
• Jonah Burke, DO
• Sandra M. Cifor, DO
• John Michael Connor, DO
• Jill Cooke
• Sandra R Cooper, PTA
• Melissa Davis, CRNP

• Occupational Therapist in Fayetteville, PA
• Providers in Fayetteville, PA by specialty
• Occupational Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.