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General NPI Number Information
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NPI Number | 1720364045
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Entity Type | Organization
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Legal Business Name | KREATIVE CONNEXIONS THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 3111 W NATIONAL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53215-1127
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Country | US
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Telephone | 414-313-5213
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Fax | 414-755-0633
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Provider Business Mailing Address
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Address Line | PO BOX 340663
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City | MILWAUKEE
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State | WI
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Zip | 53234-0663
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Country | US
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Telephone | 414-313-5213
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Fax | 414-755-0633
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LYSSA K VANG
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Credential | OTR
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Telephone | 414-313-5213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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