Provider Demographics
NPI:1255649364
Name:ATTENTION & SENSORY-MOTOR DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:ATTENTION & SENSORY-MOTOR DEVELOPMENT, LLC
Other - Org Name:ATTENTION & SENSORY-MOTOR DEVELOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:509-845-3810
Mailing Address - Street 1:1336 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:WA
Mailing Address - Zip Code:99323-8601
Mailing Address - Country:US
Mailing Address - Phone:509-845-3810
Mailing Address - Fax:888-881-3559
Practice Address - Street 1:8514 W GAGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8108
Practice Address - Country:US
Practice Address - Phone:509-845-3810
Practice Address - Fax:888-881-3559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00001974225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA876733SPEOtherUNITED HEALTHCARE
WA1987486OtherCOVENTRY HEALTHCARE
OR1558530949OtherOREGON DHS
WA5114KEOtherASURIS
WA9863141OtherAETNA
WA8519530Medicaid