Provider Demographics
NPI:1639622954
Name:SILVERSPARRE, STEVEN (MS, SCAT, ATC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SILVERSPARRE
Suffix:
Gender:M
Credentials:MS, SCAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261954
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-6054
Mailing Address - Country:US
Mailing Address - Phone:843-349-2768
Mailing Address - Fax:
Practice Address - Street 1:935 ONE LANDON LOOP
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526
Practice Address - Country:US
Practice Address - Phone:843-349-2768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1624OtherDHEC
SCBOC266201OtherBOC
SC62103OtherNATA