=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073368809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATING CONNECTIONS SLP & OT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22 OHANDLEY DR
-----------------------------------------------------
City | AMENIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12501-5536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-399-1119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22 OHANDLEY DR
-----------------------------------------------------
City | AMENIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12501-5536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-399-1119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | SARAH E LAWLOR
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 845-399-1119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QX0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------