MEDICARE: SENSATIONAL KIDS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist		WY

General Provider Information

NPI Number	:	1144605916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENSATIONAL KIDS LLC

Provider Business Mailing Address
First Line	:	918 W BRUNDAGE LN
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	903 S GREELEY HWY
Second Line	:	SUITE E
City	:	CHEYENNE
State	:	WY
Zip	:	82007-3057
Country	:	US
Telephone Number	:	307-634-2109
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHELLIE SZMYD
Credential	:
Telephone Number	:	307-673-4420

Provider Enumeration Date	:	07/22/2015
Last Update Date	:	07/22/2015

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