Healthcare Provider Details

I. General information

NPI: 1427619816
Provider Name (Legal Business Name): SENSATIONALLY BALANCED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N STONE AVE
LA GRANGE PARK IL
60526-1818
US

IV. Provider business mailing address

323 N STONE AVE
LA GRANGE PARK IL
60526-1818
US

V. Phone/Fax

Practice location:
  • Phone: 773-852-8720
  • Fax: 708-482-7432
Mailing address:
  • Phone: 773-852-8720
  • Fax: 708-482-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH MYCEK
Title or Position: OWNER
Credential: OTR/L
Phone: 773-852-8720