Provider Demographics
NPI:1508258443
Name:SPECTRUM CREATIVE ARTS LLC
Entity Type:Organization
Organization Name:SPECTRUM CREATIVE ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/DIRECTOR/MUSIC THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RESIG
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:585-383-1999
Mailing Address - Street 1:3300 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4624
Mailing Address - Country:US
Mailing Address - Phone:585-383-1999
Mailing Address - Fax:
Practice Address - Street 1:3300 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4624
Practice Address - Country:US
Practice Address - Phone:585-383-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty