Provider Demographics
NPI:1467472969
Name:CREECH, LINDA SUSAN (OCCUPATIONAL THRAPIS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:CREECH
Suffix:
Gender:F
Credentials:OCCUPATIONAL THRAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 LYNDALE DR
Mailing Address - Street 2:
Mailing Address - City:AYDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28513-7127
Mailing Address - Country:US
Mailing Address - Phone:252-746-2547
Mailing Address - Fax:252-746-6646
Practice Address - Street 1:3919 LYNDALE DR
Practice Address - Street 2:
Practice Address - City:AYDEN
Practice Address - State:NC
Practice Address - Zip Code:28513-7127
Practice Address - Country:US
Practice Address - Phone:252-746-2547
Practice Address - Fax:252-746-6646
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210638Medicaid