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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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