MEDICARE: CREATIVE THERAPIES OF WNY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency	008726-1	NY

General Provider Information

NPI Number	:	1649548868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE THERAPIES OF WNY

Provider Business Mailing Address
First Line	:	7303 WINDSOR DR
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3739
Country	:	US
Telephone Number	:	716-472-1289
Fax Number	:	716-689-2916

Provider Business Practice Location Address
First Line	:	7303 WINDSOR DR
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-3739
Country	:	US
Telephone Number	:	716-472-1289
Fax Number	:	716-689-2916

Authorized Official
Title or Position	:	CEO/CO-OWNER
Name	:	MS. PATRICIA A JEFFRIES
Credential	:
Telephone Number	:	716-472-1289

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	12/02/2011

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Directions to “CREATIVE THERAPIES OF WNY ” Practice Location

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