Healthcare Provider Details

I. General information

NPI: 1922100809
Provider Name (Legal Business Name): SENSATIONAL KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LICK CREEK RD
ANNA IL
62906-3270
US

IV. Provider business mailing address

130 LICK CREEK RD
ANNA IL
62906-3270
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-4300
  • Fax: 618-833-4336
Mailing address:
  • Phone: 618-833-4300
  • Fax: 618-833-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: ELIZABETH W WHEELER
Title or Position: OWNER
Credential: OTR/L
Phone: 618-833-4300