Provider Demographics
NPI:1356466775
Name:CREEDON, ELAINE MARIE (OTA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:CREEDON
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3760
Mailing Address - Country:US
Mailing Address - Phone:978-345-8631
Mailing Address - Fax:
Practice Address - Street 1:44 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1904
Practice Address - Country:US
Practice Address - Phone:978-537-9327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA854224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant