Healthcare Provider Details

I. General information

NPI: 1306381769
Provider Name (Legal Business Name): CREATIVE CARE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 7TH ST
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

19 7TH ST
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 732-789-2485
  • Fax:
Mailing address:
  • Phone: 732-789-2485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code225XL0004X
TaxonomyLow Vision Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR00021900
License Number StateNJ
# 12
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01593000
License Number StateNJ
# 13
Primary TaxonomyN
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number40QA01593000
License Number StateNJ
# 14
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number40QA01593000
License Number StateNJ
# 15
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00021900
License Number StateNJ

VIII. Authorized Official

Name: RANANA LEEDER
Title or Position: REGISTERED AGENT
Credential:
Phone: 732-789-2485