# KIDS CREEK THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700983772
- **Authorized official:** MYRLAINE DARIUS (ADMIN DIRECTOR)
- **Authorized official phone:** (770) 888-5221

## Contact information

- **Practice address:** 4055 JOHNS CREEK PKWY STE A, SUWANEE, GA 30024-1299
- **Practice address phone:** (770) 888-5221
- **Practice address fax:** (678) 680-5929
- **Mailing address:** 4055 JOHNS CREEK PKWY STE A, SUWANEE, GA 30024-1299
- **Mailing address phone:** (770) 888-5221
- **Mailing address fax:** (678) 680-5929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 106E00000X | Assistant Behavior Analyst | — | NULL | — |
| 106E00000X | Assistant Behavior Analyst | — | — | — |
| 106S00000X | Behavior Technician | — | NULL | — |
| 106S00000X | Behavior Technician | — | — | — |
| 225100000X | Physical Therapist | PT008420 | GA | — |
| 225100000X | Physical Therapist | PT008827 | GA | — |
| 225X00000X | Occupational Therapist | OT001067 | GA | — |
| 225X00000X | Occupational Therapist | OT001466 | GA | — |
| 225X00000X | Occupational Therapist | OT003625 | GA | — |
| 225X00000X | Occupational Therapist | OT003747 | GA | — |
| 235Z00000X | Speech-Language Pathologist | SLP004267 | GA | — |
| 235Z00000X | Speech-Language Pathologist | SLP004972 | GA | — |
| 235Z00000X | Speech-Language Pathologist | SLP005105 | GA | — |
| 235Z00000X | Speech-Language Pathologist | SLP005895 | GA | — |
| 235Z00000X | Speech-Language Pathologist | SLP006187 | GA | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 10/02/2023