Provider Demographics
NPI:1730310582
Name:SENSATIONAL KIDS PHYSICAL, OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:SENSATIONAL KIDS PHYSICAL, OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Other - Org Name:SENSATIONAL KIDS, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-725-9644
Mailing Address - Street 1:87 ELLIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-9540
Mailing Address - Country:US
Mailing Address - Phone:607-948-4047
Mailing Address - Fax:607-948-4097
Practice Address - Street 1:87 ELLIS CREEK RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9540
Practice Address - Country:US
Practice Address - Phone:607-948-4047
Practice Address - Fax:607-948-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023247252Y00000X
NY17259252Y00000X
NY11909252Y00000X
NY17452252Y00000X
NY7215252Y00000X
NY16366252Y00000X
NY40581252Y00000X
NY13415252Y00000X
NY13075252Y00000X
NY29578252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency