Provider Demographics
NPI:1811261928
Name:CREATIVE THERAPY SOLUTIONS LLC
Entity type:Organization
Organization Name:CREATIVE THERAPY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SPEECH LANGUAGE PATHOLOGIS
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD, CCC-SLP
Authorized Official - Phone:561-641-5757
Mailing Address - Street 1:2168 JOG RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6015
Mailing Address - Country:US
Mailing Address - Phone:561-641-5757
Mailing Address - Fax:561-641-7373
Practice Address - Street 1:2168 JOG RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-6015
Practice Address - Country:US
Practice Address - Phone:561-641-5757
Practice Address - Fax:561-641-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X
FLSA6347235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001049100Medicaid
FL109652000Medicaid