Provider Demographics
NPI:1568707990
Name:SENSATION STATION GUILFORD INC
Entity type:Organization
Organization Name:SENSATION STATION GUILFORD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:FEDORUK
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:203-458-1000
Mailing Address - Street 1:725 BOSTON POST RD
Mailing Address - Street 2:STE 3
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2736
Mailing Address - Country:US
Mailing Address - Phone:203-458-1000
Mailing Address - Fax:203-286-1688
Practice Address - Street 1:725 BOSTON POST RD
Practice Address - Street 2:STE 3
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2736
Practice Address - Country:US
Practice Address - Phone:917-279-0906
Practice Address - Fax:203-286-1688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 104100000X, 224Z00000X, 2251P0200X, 225200000X, 225XP0200X, 235Z00000X
CT002800225X00000X, 225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & SwallowingGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty