Provider Demographics
NPI:1134563075
Name:KREATIVE KIDS THERAPY CENTER CO
Entity type:Organization
Organization Name:KREATIVE KIDS THERAPY CENTER CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:305-305-9665
Mailing Address - Street 1:8491 NW 17TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1025
Mailing Address - Country:US
Mailing Address - Phone:305-456-5542
Mailing Address - Fax:305-442-0594
Practice Address - Street 1:8491 NW 17TH ST STE 110
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1025
Practice Address - Country:US
Practice Address - Phone:305-456-5542
Practice Address - Fax:786-364-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty