Healthcare Provider Details

I. General information

NPI: 1659280113
Provider Name (Legal Business Name): A SENSORY PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N 119TH LN
AVONDALE AZ
85323-7220
US

IV. Provider business mailing address

414 N 119TH LN
AVONDALE AZ
85323-7220
US

V. Phone/Fax

Practice location:
  • Phone: 602-935-5188
  • Fax:
Mailing address:
  • Phone: 602-935-5188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NASHARAE CARABALLO
Title or Position: OWNER
Credential:
Phone: 602-935-5188