Provider Demographics
NPI:1275043887
Name:CREATIVE OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CREATIVE OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIVAK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:305-776-6577
Mailing Address - Street 1:21061 WINDEMERE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1116
Mailing Address - Country:US
Mailing Address - Phone:305-776-6577
Mailing Address - Fax:
Practice Address - Street 1:21061 WINDEMERE LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1116
Practice Address - Country:US
Practice Address - Phone:305-776-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty