Provider Demographics
NPI:1093522807
Name:CREEKSIDE PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:CREEKSIDE PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLAISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-232-2832
Mailing Address - Street 1:141 N HILL DR
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8129
Mailing Address - Country:US
Mailing Address - Phone:601-215-3267
Mailing Address - Fax:
Practice Address - Street 1:141 N HILL DR
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8129
Practice Address - Country:US
Practice Address - Phone:601-215-3267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty