Provider Demographics
NPI:1699047050
Name:SENSORY SYSTEMS CLINIC WEST, PLC
Entity type:Organization
Organization Name:SENSORY SYSTEMS CLINIC WEST, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OT
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCOURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-792-2353
Mailing Address - Street 1:145 S MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1702
Mailing Address - Country:US
Mailing Address - Phone:269-792-2353
Mailing Address - Fax:269-792-2847
Practice Address - Street 1:145 S MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1702
Practice Address - Country:US
Practice Address - Phone:269-792-2353
Practice Address - Fax:269-792-2847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007520225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5239Medicare UPIN