Provider Demographics
NPI:1063876811
Name:CREECH, BILLIE JEWELL (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:JEWELL
Last Name:CREECH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 N ASHLEY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5945
Mailing Address - Country:US
Mailing Address - Phone:229-253-8500
Mailing Address - Fax:229-253-8522
Practice Address - Street 1:4900 TILLMAN XING
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-4108
Practice Address - Country:US
Practice Address - Phone:229-251-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002038224Z00000X
GAOT008560225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOTA002038OtherGEORGIA SECRETARY OF STATE