Provider Demographics
NPI:1659562544
Name:CREADON, BRIAN P (OT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:CREADON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1331
Mailing Address - Country:US
Mailing Address - Phone:813-748-3510
Mailing Address - Fax:
Practice Address - Street 1:12625 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1331
Practice Address - Country:US
Practice Address - Phone:813-748-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL205316070OtherTAX ID#