Healthcare Provider Details

I. General information

NPI: 1235188780
Provider Name (Legal Business Name): CREATIVE HANDS OCCUPATIONAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PHYSICIANS DR STE 106
SUPPLY NC
28462-4216
US

IV. Provider business mailing address

58 PHYSICIANS DR STE 106
SUPPLY NC
28462-4216
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-6075
  • Fax: 910-755-6076
Mailing address:
  • Phone: 910-755-6075
  • Fax: 910-755-6076

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: MS. SUSAN OLMSCHENK
Title or Position: OWNER PRESIDENT
Credential: OTR L
Phone: 910-755-6075