Provider Demographics
NPI:1134417652
Name:SENSORY-MOTOR THERAPEUTICS, INC.
Entity type:Organization
Organization Name:SENSORY-MOTOR THERAPEUTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:309-966-2772
Mailing Address - Street 1:2102 W FORESTGLEN DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-4904
Mailing Address - Country:US
Mailing Address - Phone:309-966-2772
Mailing Address - Fax:
Practice Address - Street 1:2102 W FORESTGLEN DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-4904
Practice Address - Country:US
Practice Address - Phone:309-966-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.004578252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency