Organization
CREATIVE DEVELOPMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNE ANDERSON OTR/L (MANAGING MEMBER)
(860) 284-9779
Entity
Organization
Contact information
Practice address
30 AVON MEADOW LN, AVON, CT 06001-3745
(860) 833-9905
(860) 409-2190
Mailing address
PO BOX 421, AVON, CT 06001-0421
(860) 284-9779
(860) 409-2190
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000957
CT
235Z00000X
Speech-Language Pathologist
001742
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008047516
—
CT
Enumeration date
08/24/2007
Last updated
04/07/2016
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