Healthcare Provider Details

I. General information

NPI: 1508428673
Provider Name (Legal Business Name): SENSORY KIDS IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 COMMUNITY DRIVE UNIT H
NORTH LIBERTY IA
52317
US

IV. Provider business mailing address

220 KNOWLING DR
CORALVILLE IA
52241-3331
US

V. Phone/Fax

Practice location:
  • Phone: 319-626-2257
  • Fax: 319-359-4015
Mailing address:
  • Phone: 319-333-9807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TERESA MICHELLE GRUETER
Title or Position: OWNER
Credential: OTR
Phone: 319-333-9807