MEDICARE: CREATIVE PLAY LP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	252Y00000X	Early Intervention Provider Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720353543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE PLAY LP

Provider Business Mailing Address
First Line	:	7711 S RAEFORD RD
Second Line	:	SUITE 102 #134
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5986
Country	:	US
Telephone Number	:	910-670-6317
Fax Number	:	910-493-3020

Provider Business Practice Location Address
First Line	:	7711 S RAEFORD RD
Second Line	:	SUITE 102 #134
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-5986
Country	:	US
Telephone Number	:	910-670-6317
Fax Number	:	910-493-3020

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER/DIRECTOR
Name	:	MS. LORIANN E KINNEY
Credential	:
Telephone Number	:	910-670-6317

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	12/03/2019

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Directions to “CREATIVE PLAY LP ” Practice Location

Language	Start Address	Practice Location

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