Basic Information
| Provider Information | |||||||||
| NPI: | 1114327525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREECH | ||||||||
| FirstName: | BRANDON | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1871 FALLS BLVD. NORTH | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702088989 | ||||||||
| FaxNumber: | 8702088107 | ||||||||
| Practice Location | |||||||||
| Address1: | 1871 FALLS BLVD. NORTH | ||||||||
| Address2: | |||||||||
| City: | WYNNE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8702088989 | ||||||||
| FaxNumber: | 8702088107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | TOC102958 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OTR2811 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.