Provider Demographics
NPI:1104101674
Name:SENSATIONAL KIDS PHYSICAL, OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:SENSATIONAL KIDS PHYSICAL, OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-948-4047
Mailing Address - Street 1:332 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892
Mailing Address - Country:US
Mailing Address - Phone:607-948-4047
Mailing Address - Fax:607-565-2200
Practice Address - Street 1:332 BROAD ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892
Practice Address - Country:US
Practice Address - Phone:607-948-4047
Practice Address - Fax:607-565-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021178-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency