Healthcare Provider Details

I. General information

NPI: 1851605604
Provider Name (Legal Business Name): SENSATIONAL KIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E BRUNDAGE LN STE E
SHERIDAN WY
82801-6280
US

IV. Provider business mailing address

520 S BROOKS ST
SHERIDAN WY
82801-4707
US

V. Phone/Fax

Practice location:
  • Phone: 307-673-4420
  • Fax: 307-673-4420
Mailing address:
  • Phone: 307-673-4420
  • Fax: 307-673-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR-787
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SZMYD
Title or Position: OWNER
Credential: OTR/L
Phone: 307-673-4420