=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871616144
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORI CREACH OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 S EWING TRL UNIT 1190
-----------------------------------------------------
City | TONTO BASIN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85553-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-628-8160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 S EWING TRL UNIT 1190
-----------------------------------------------------
City | TONTO BASIN
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85553-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-628-8160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------