Provider Demographics
NPI:1679726962
Name:CRETA, CLAUDIA (OT/L)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:CRETA
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10441 NW 18TH DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-3544
Mailing Address - Country:US
Mailing Address - Phone:954-579-2007
Mailing Address - Fax:954-382-1866
Practice Address - Street 1:10441 NW 18TH DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-3544
Practice Address - Country:US
Practice Address - Phone:954-579-2007
Practice Address - Fax:954-382-1866
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11291225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890515100Medicaid