Provider Demographics
NPI:1396857165
Name:SPEARS, MICHAEL KEVIN (OT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEVIN
Last Name:SPEARS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:AR
Mailing Address - Zip Code:72360-2015
Mailing Address - Country:US
Mailing Address - Phone:870-295-2361
Mailing Address - Fax:
Practice Address - Street 1:1015 LEE DR
Practice Address - Street 2:SUITE 1 B
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-3698
Practice Address - Country:US
Practice Address - Phone:662-624-2466
Practice Address - Fax:662-624-4876
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT2033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist