1942760152 NPI number — SENSORY 8 PEDIATRIC THERAPY, LLC

Table of content: (NPI 1942760152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942760152 NPI number — SENSORY 8 PEDIATRIC THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENSORY 8 PEDIATRIC THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942760152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5705 CARTER WOODS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXHAW
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28173-6974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
803-728-3291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6277-600 CAROLINA COMMONS #378
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN LAND
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29707-6974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-730-9411
Provider Business Practice Location Address Fax Number:
803-728-3291
Provider Enumeration Date:
03/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KOCHOBAY
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
267-730-9411

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GP8975 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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