Provider Demographics
NPI:1124477559
Name:CREATIVE OCCUPATIONAL THERAPY SOLUTIONS
Entity type:Organization
Organization Name:CREATIVE OCCUPATIONAL THERAPY SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RABENECK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-225-4260
Mailing Address - Street 1:1812 GRAND VILLA DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8991
Mailing Address - Country:US
Mailing Address - Phone:502-225-4260
Mailing Address - Fax:
Practice Address - Street 1:1812 GRAND VILLA DR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8991
Practice Address - Country:US
Practice Address - Phone:502-225-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5453261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service