An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Developmental Disabilities |
261QD1600X | |||
Pediatrics |
2251P0200X | 65 | Physical Therapist in Private Practice | |
Pediatrics |
225XP0200X | 67 | Occupational Therapist in Private Practice | |
Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
320600000X | |||
Speech-Language Pathologist |
235Z00000X | 15 | Speech Language Pathologist |
| NPI Number | 1184703670 |
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| LBN Legal business name | CREATIVE LIFE SKILLS DEVELOPMENT | ||||
| Authorized official | LISA HERRMANN - (OWNER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 11/03/2006 | ||||
| Last updated | 09/07/2011 - About 15 years ago | ||||
| Identifiers |
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