MEDICARE: SENSATIONAL OCCUPATIONAL THERAPY,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	12817	FL

General Provider Information

NPI Number	:	1407006232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENSATIONAL OCCUPATIONAL THERAPY,LLC

Provider Business Mailing Address
First Line	:	4829 INNISBROOK CT S
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2067
Country	:	US
Telephone Number	:	904-557-8972
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 INNISBROOK CT S
Second Line	:
City	:	ELKTON
State	:	FL
Zip	:	32033-2067
Country	:	US
Telephone Number	:	904-557-8972
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	AMANDA AUGUST
Credential	:	M.S. OTR/L
Telephone Number	:	904-557-8972

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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