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General NPI Number Information
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NPI Number | 1710687033
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Entity Type | Organization
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Legal Business Name | CREATIVE MIND OCCUPATIONAL THERAPY LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 11/12/2023
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Provider Practice Location Address
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Address Line | 136 S LUDLOW ST
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City | DAYTON
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State | OH
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Zip | 45402-1813
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Country | US
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Telephone | 859-412-1048
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 340380 OMB 828886
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City | COLUMBUS
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State | OH
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Zip | 43234-0380
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Country | US
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Telephone | 859-412-1048
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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 | MS. LUCIA H. LEE
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Credential | MSOT, OTR/L
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Telephone | 859-412-1048
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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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