Provider Demographics
NPI:1083996755
Name:THERAPY SPOT LLC
Entity Type:Organization
Organization Name:THERAPY SPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:912-681-7768
Mailing Address - Street 1:518 GENTILLY RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-5149
Mailing Address - Country:US
Mailing Address - Phone:912-681-7768
Mailing Address - Fax:912-681-7782
Practice Address - Street 1:518 GENTILLY RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5149
Practice Address - Country:US
Practice Address - Phone:912-681-7768
Practice Address - Fax:912-681-7782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty