Provider Demographics
NPI:1720353543
Name:CREATIVE PLAY LP
Entity Type:Organization
Organization Name:CREATIVE PLAY LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORIANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-670-6317
Mailing Address - Street 1:7711 S RAEFORD RD
Mailing Address - Street 2:SUITE 102 #134
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-5986
Mailing Address - Country:US
Mailing Address - Phone:910-670-6317
Mailing Address - Fax:910-493-3020
Practice Address - Street 1:7711 S RAEFORD RD
Practice Address - Street 2:SUITE 102 #134
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-5986
Practice Address - Country:US
Practice Address - Phone:910-670-6317
Practice Address - Fax:910-493-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency