=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285941781
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATEABILITIES OT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2010
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 5TH AVE SUITE 201
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-685-3266
-----------------------------------------------------
Fax | 212-685-3224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 5TH AVE SUITE 201
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-6405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-685-3266
-----------------------------------------------------
Fax | 212-685-3224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. VANESSA GIARDINA
-----------------------------------------------------
Credential | MA, OTR/L
-----------------------------------------------------
Telephone | 212-685-3266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 005678-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------