Healthcare Provider Details

I. General information

NPI: 1942760152
Provider Name (Legal Business Name): SENSORY 8 PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6277-600 CAROLINA COMMONS #378
INDIAN LAND SC
29707-6974
US

IV. Provider business mailing address

5705 CARTER WOODS CT
WAXHAW NC
28173-6974
US

V. Phone/Fax

Practice location:
  • Phone: 267-730-9411
  • Fax: 803-728-3291
Mailing address:
  • Phone:
  • Fax: 803-728-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA KOCHOBAY
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 267-730-9411