Provider Demographics
NPI:1235188780
Name:CREATIVE HANDS OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:CREATIVE HANDS OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMSCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR L
Authorized Official - Phone:910-755-6075
Mailing Address - Street 1:58 PHYSICIANS DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4216
Mailing Address - Country:US
Mailing Address - Phone:910-755-6075
Mailing Address - Fax:910-755-6076
Practice Address - Street 1:58 PHYSICIANS DR STE 106
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4216
Practice Address - Country:US
Practice Address - Phone:910-755-6075
Practice Address - Fax:910-755-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211080Medicaid
NC7301202Medicaid