Healthcare Provider Details

I. General information

NPI: 1700791738
Provider Name (Legal Business Name): KREATIVE THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 2ND ST E
TIFTON GA
31794-4408
US

IV. Provider business mailing address

6 PIKE CREEK RD
ADEL GA
31620-9422
US

V. Phone/Fax

Practice location:
  • Phone: 850-290-2217
  • Fax:
Mailing address:
  • Phone: 229-415-8242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KRISTY F PENUEL
Title or Position: OWNER
Credential: MOT, BS, BBM, COTA
Phone: 229-415-8242