Individual
MR. BRIAN P CREADON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
12625 RACE TRACK RD, TAMPA, FL 33626-1331
(813) 748-3510
Mailing address
12625 RACE TRACK RD, TAMPA, FL 33626-1331
(813) 748-3510
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT4582
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205316070
TAX ID#
FL
Enumeration date
08/06/2007
Last updated
08/19/2009
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