Healthcare Provider Details

I. General information

NPI: 1467700765
Provider Name (Legal Business Name): SENSATIONAL KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 KILGORE DR
ASHLAND KY
41101-3118
US

IV. Provider business mailing address

901 KILGORE DR
ASHLAND KY
41101-3118
US

V. Phone/Fax

Practice location:
  • Phone: 606-831-8752
  • Fax:
Mailing address:
  • Phone: 606-831-8752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR1895
License Number StateKY

VIII. Authorized Official

Name: JACKIE MARTIN
Title or Position: OWNER
Credential: OTR/L
Phone: 606-831-8752