Healthcare Provider Details

I. General information

NPI: 1073339305
Provider Name (Legal Business Name): CREATIVELY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8395 W OAKLAND PARK BLVD STE C
SUNRISE FL
33351-7346
US

IV. Provider business mailing address

999 BRICKELL AVE STE 410
MIAMI FL
33131-3041
US

V. Phone/Fax

Practice location:
  • Phone: 786-659-5296
  • Fax: 561-448-7160
Mailing address:
  • Phone: 786-659-5296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS HESSEL
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 786-675-8083