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General NPI Number Information
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NPI Number | 1073339305
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Entity Type | Organization
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Legal Business Name | CREATIVELY CLINIC LLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 8395 W OAKLAND PARK BLVD STE C
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City | SUNRISE
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State | FL
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Zip | 33351-7346
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Country | US
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Telephone | 786-659-5296
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Fax | 561-448-7160
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Provider Business Mailing Address
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Address Line | 999 BRICKELL AVE STE 410
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City | MIAMI
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State | FL
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Zip | 33131-3041
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Country | US
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Telephone | 786-659-5296
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MR. THOMAS HESSEL
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Credential |
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Telephone | 786-675-8083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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