Healthcare Provider Details

I. General information

NPI: 1598151326
Provider Name (Legal Business Name): KIDSENSE THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CHERRY ST
MILFORD CT
06460-3501
US

IV. Provider business mailing address

209 CHERRY ST
MILFORD CT
06460-3501
US

V. Phone/Fax

Practice location:
  • Phone: 203-874-5437
  • Fax: 203-301-0552
Mailing address:
  • Phone: 203-874-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number008591
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GRIFFITH
Title or Position: OWNER
Credential: COTA/L
Phone: 203-874-5437