Provider Demographics
NPI:1396193512
Name:SPECTRUM THERAPY SOLUTIONS
Entity Type:Organization
Organization Name:SPECTRUM THERAPY SOLUTIONS
Other - Org Name:PEDIATRIC THERAPY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:SAUNDERS
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LOTR
Authorized Official - Phone:225-622-7208
Mailing Address - Street 1:16172 AIRLINE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4212
Mailing Address - Country:US
Mailing Address - Phone:225-622-7208
Mailing Address - Fax:
Practice Address - Street 1:16172 AIRLINE HWY STE B
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-4212
Practice Address - Country:US
Practice Address - Phone:225-622-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11219261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty