Sandra I. Creech, DEVELOPMENTAL INTERV
Individual provider Active NPI Developmental Therapist · Premium, KY
NPI 1699985143 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1699985143
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- License
- FS-01838 (KY)
- Practice address
- 2127 Hwy160 South
Premium, KY 41845 - Phone
- (606) 633-4036
- Fax
- (606) 633-4036
- NPI assigned
- May 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| FS-01838 | KY | MD | Developmental Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | FS-01838 | KY | Yes |
Addresses
Primary practice location
2127 Hwy160 South
Premium, KY 41845
Mailing address
2127 Hwy160 South
Premium, KY 41845
Phone (606) 633-4036
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.