Healthcare Provider Details

I. General information

NPI: 1710291125
Provider Name (Legal Business Name): CREATIVE HANDS OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 US HIGHWAY 17 S SUITE 5
HOLLY RIDGE NC
28445-8660
US

IV. Provider business mailing address

624 US HIGHWAY 17 S SUITE 4
HOLLY RIDGE NC
28445-8660
US

V. Phone/Fax

Practice location:
  • Phone: 910-329-4444
  • Fax: 910-329-4445
Mailing address:
  • Phone: 910-329-4444
  • Fax: 910-329-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MAUREEN OLMSCHENK
Title or Position: OWNER/PRESIDENT
Credential: OTR/L
Phone: 910-755-6075