Healthcare Provider Details

I. General information

NPI: 1073368809
Provider Name (Legal Business Name): CREATING CONNECTIONS SLP & OT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 OHANDLEY DR
AMENIA NY
12501-5536
US

IV. Provider business mailing address

22 OHANDLEY DR
AMENIA NY
12501-5536
US

V. Phone/Fax

Practice location:
  • Phone: 845-399-1119
  • Fax:
Mailing address:
  • Phone: 845-399-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH E LAWLOR
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS
Phone: 845-399-1119