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General NPI Number Information
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NPI Number | 1134417652
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Entity Type | Organization
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Legal Business Name | SENSORY-MOTOR THERAPEUTICS, INC.
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 2102 W FORESTGLEN DR
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City | PEORIA
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State | IL
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Zip | 61615-4904
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Country | US
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Telephone | 309-966-2772
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Fax |
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Provider Business Mailing Address
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Address Line | 2102 W FORESTGLEN DR
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City | PEORIA
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State | IL
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Zip | 61615-4904
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Country | US
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Telephone | 309-966-2772
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | KRISTI BAUER
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Credential | OTR/L
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Telephone | 309-966-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 056.004578
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License Number State | IL
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