Provider Demographics
NPI:1356452882
Name:SENSATIONAL KIDS THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:SENSATIONAL KIDS THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:229-563-0811
Mailing Address - Street 1:6595 COLE RD
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3621
Mailing Address - Country:US
Mailing Address - Phone:229-563-0811
Mailing Address - Fax:229-794-8009
Practice Address - Street 1:6595 COLE RD
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-3621
Practice Address - Country:US
Practice Address - Phone:229-563-0811
Practice Address - Fax:229-794-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000885849EMedicaid