Healthcare Provider Details

I. General information

NPI: 1255300257
Provider Name (Legal Business Name): CREATIVE CHILDREN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12608 SW 88TH ST
MIAMI FL
33186-1867
US

IV. Provider business mailing address

12608 SW 88TH ST
MIAMI FL
33186-1867
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-4177
  • Fax: 305-412-4181
Mailing address:
  • Phone: 305-412-4177
  • Fax: 305-412-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MARIA CRISTINA ARRAZOLA
Title or Position: VICE PRESIDENT
Credential:
Phone: 305-412-4177