Organization
CREATIVE LIFE SKILLS DEVELOPMENT
Active
Organization
CREATIVE LIFE SKILLS DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA LYN HERRMANN M.S OTR/L (OWNER)
(602) 441-5975
Entity
Organization
Contact information
Practice address
15508 W BELL RD, SUITE 101-261, SURPRISE, AZ 85374-2432
(602) 441-5975
(602) 485-8859
Mailing address
15508 W BELL RD, SUITE 101-261, SURPRISE, AZ 85374-2432
(602) 441-5975
(602) 485-8859
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
2762
AZ
Other
Enumeration date
11/03/2006
Last updated
09/07/2011
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