Interactive Creative Therapy Inc

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

INTERACTIVE CREATIVE THERAPY INC

Practice address

18 W 21St St
Deer Park, NY 11729-3918

Phone

(631) 306-4053

NPI assigned

Jan 19, 2020

Organization subpart

No

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

Authorized official

Name

Dechantal Montano, OT

Title

President

Phone

(580) 402-6704

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1579392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579392000000",
    "number": "1316577307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MASSACHUSETTS AVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117766101",
            "telephone_number": "631-790-2584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 W 21ST ST",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117293918",
            "telephone_number": "631-306-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERACTIVE CREATIVE THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-19",
        "last_updated": "2020-01-19",
        "certification_date": "2020-01-19",
        "status": "A",
        "authorized_official_last_name": "MONTANO",
        "authorized_official_first_name": "DECHANTAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-402-6704",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Deer Park, NY
• Providers in Deer Park, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2020; 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.