Healthcare Provider Details

I. General information

NPI: 1922162866
Provider Name (Legal Business Name): SENSATIONAL KIDS OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 RIDGEFIELD RD STE C
THIBODAUX LA
70301-4399
US

IV. Provider business mailing address

1713 RIDGEFIELD RD STE C
THIBODAUX LA
70301-4399
US

V. Phone/Fax

Practice location:
  • Phone: 985-449-0944
  • Fax: 985-449-0945
Mailing address:
  • Phone: 985-449-0944
  • Fax: 985-449-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberZ12274
License Number StateLA

VIII. Authorized Official

Name: HEATHER HARRIS
Title or Position: MANAGER
Credential: OTD, LOTR
Phone: 985-449-0944