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General NPI Number Information
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NPI Number | 1588890875
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Entity Type | Organization
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Legal Business Name | CREATIVE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 2003 SOUTHERN BLVD SE STE 133
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City | RIO RANCHO
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State | NM
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Zip | 87124-3751
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Country | US
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Telephone | 505-891-3999
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Fax | 505-821-7671
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Provider Business Mailing Address
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Address Line | 2003 SOUTHERN BLVD SE STE 133
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City | RIO RANCHO
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State | NM
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Zip | 87124-3751
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Country | US
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Telephone | 505-891-3999
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Fax | 505-821-7671
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MRS. HOLLYE ANN KOZLOWSKI
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Credential | OTR/L
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Telephone | 505-891-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1795
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License Number State | NM
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