Provider Demographics
NPI:1639685399
Name:SENSORY BOUNCE, LLC
Entity Type:Organization
Organization Name:SENSORY BOUNCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:SKYDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:201-794-7700
Mailing Address - Street 1:16-00 ROUTE 208
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2503
Mailing Address - Country:US
Mailing Address - Phone:201-759-4465
Mailing Address - Fax:
Practice Address - Street 1:16-00 ROUTE 208
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2503
Practice Address - Country:US
Practice Address - Phone:201-759-4465
Practice Address - Fax:201-759-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00169900225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty