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General NPI Number Information
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NPI Number | 1124477559
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Entity Type | Organization
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Legal Business Name | CREATIVE OCCUPATIONAL THERAPY SOLUTIONS
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 1812 GRAND VILLA DR
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City | LA GRANGE
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State | KY
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Zip | 40031-8991
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Country | US
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Telephone | 502-225-4260
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 GRAND VILLA DR
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City | LA GRANGE
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State | KY
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Zip | 40031-8991
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Country | US
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Telephone | 502-225-4260
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ANGELA ANN RABENECK
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Credential | OTR/L
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Telephone | 502-225-4260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | R5453
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License Number State | KY
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