Provider Demographics
NPI:1255300257
Name:CREATIVE CHILDREN THERAPY
Entity Type:Organization
Organization Name:CREATIVE CHILDREN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:ARRAZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-412-4177
Mailing Address - Street 1:12608 SW 88TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1867
Mailing Address - Country:US
Mailing Address - Phone:305-412-4177
Mailing Address - Fax:305-412-4181
Practice Address - Street 1:12608 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1867
Practice Address - Country:US
Practice Address - Phone:305-412-4177
Practice Address - Fax:305-412-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888947300Medicaid