Provider Demographics
NPI:1457892143
Name:CREATIVE OT SOLUTIONS, LLC
Entity Type:Organization
Organization Name:CREATIVE OT SOLUTIONS, LLC
Other - Org Name:CREATIVE THERAPY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:571-245-6985
Mailing Address - Street 1:6190 OLD FRANCONIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2593
Mailing Address - Country:US
Mailing Address - Phone:571-245-6985
Mailing Address - Fax:
Practice Address - Street 1:6190 OLD FRANCONIA RD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2593
Practice Address - Country:US
Practice Address - Phone:571-245-6985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17-CREA261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)