Healthcare Provider Details

I. General information

NPI: 1508603242
Provider Name (Legal Business Name): KATIE CREECH OTD R/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8706 S US HIGHWAY 25
CORBIN KY
40701-4974
US

IV. Provider business mailing address

390 SPRING ST APT A
LONDON KY
40741-2102
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number293508
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: