Provider Demographics
NPI:1033385992
Name:CYNTHIA S. CREIGHTON, M.S., OTR
Entity Type:Organization
Organization Name:CYNTHIA S. CREIGHTON, M.S., OTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIOTER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:574-202-6640
Mailing Address - Street 1:PO BOX 2902
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-2902
Mailing Address - Country:US
Mailing Address - Phone:574-202-6640
Mailing Address - Fax:574-534-8733
Practice Address - Street 1:2107 CAMBRIDGE DR APT C
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-5703
Practice Address - Country:US
Practice Address - Phone:574-202-6640
Practice Address - Fax:574-534-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31000164A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty