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General NPI Number Information
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NPI Number | 1093522807
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Entity Type | Organization
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Legal Business Name | CREEKSIDE PEDIATRIC THERAPY LLC
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 141 N HILL DR
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City | CARRIERE
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State | MS
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Zip | 39426-8129
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Country | US
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Telephone | 601-215-3267
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Fax |
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Provider Business Mailing Address
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Address Line | 141 N HILL DR
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City | CARRIERE
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State | MS
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Zip | 39426-8129
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Country | US
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Telephone | 601-215-3267
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/OWNER
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Name | HEIDI MOLAISON
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Credential |
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Telephone | 985-232-2832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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