MEDICARE: KID SENSE THERAPY, PLLC

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	222Q00000X	Developmental Therapist
2	225100000X	Physical Therapist
3	225X00000X	Occupational Therapist	4264	NC
4	235Z00000X	Speech-Language Pathologist
5	252Y00000X	Early Intervention Provider Agency	4264	NC

General Provider Information

NPI Number	:	1821426933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KID SENSE THERAPY, PLLC

Provider Business Mailing Address
First Line	:	324 BENDEMEER LN
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9731
Country	:	US
Telephone Number	:	919-263-9605
Fax Number	:	919-263-9605

Provider Business Practice Location Address
First Line	:	324 BENDEMEER LN
Second Line	:
City	:	ROLESVILLE
State	:	NC
Zip	:	27571-9731
Country	:	US
Telephone Number	:	919-263-9605
Fax Number	:	919-263-9605

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MRS. SUSAN MICHELE POWELL
Credential	:	OTR/L
Telephone Number	:	919-673-4246

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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