NPIMap

Organization Active NPI

Creative Development, LLC

  • Specialist
  • Avon, CT
National Provider Identifier
1295928075
Registry record updated Apr 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
000957 Issued in CT
Legal business name
CREATIVE DEVELOPMENT, LLC
Practice address
30 Avon Meadow LN
Avon, CT 06001-3745
Phone
(860) 833-9905
Fax
(860) 409-2190
NPI assigned
Aug 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deanne Anderson, OTR/L
Title
Managing Member
Phone
(860) 284-9779

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 000957 CT Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 001742 CT

Addresses

Primary practice location

30 Avon Meadow LN
Avon, CT 06001-3745

Mailing address

PO Box 421
Avon, CT 06001-0421
Phone (860) 284-9779

Other identifiers 1

IdentifierTypeStateIssuer
008047516MedicaidCT

National Provider Directory

National Provider Directory

Locations

30 Avon Meadow Ln
Avon, CT 06001
Phone (860) 284-9779

110 Hopmeadow St
Ste 400
Weatogue, CT 06089

110 Hopmeadow St
Weatogue, CT 06089
Phone (860) 284-9779

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1295928075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 421",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060010421",
            "telephone_number": "860-284-9779",
            "fax_number": "860-409-2190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 AVON MEADOW LN",
            "city": "AVON",
            "state": "CT",
            "postal_code": "060013745",
            "telephone_number": "860-833-9905",
            "fax_number": "860-409-2190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREATIVE DEVELOPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DEANNE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "860-284-9779",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "000957",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "CT",
            "license": "001742",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008047516",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Avon, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.