Provider Demographics
NPI:1134243363
Name:CREATIVE INTERVENTIONS INC
Entity type:Organization
Organization Name:CREATIVE INTERVENTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:303-499-7721
Mailing Address - Street 1:4005 MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5431
Mailing Address - Country:US
Mailing Address - Phone:303-499-7721
Mailing Address - Fax:303-499-2638
Practice Address - Street 1:4005 MARTIN DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5431
Practice Address - Country:US
Practice Address - Phone:303-499-7721
Practice Address - Fax:303-499-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58428321Medicaid
CO58428321Medicaid