Provider Demographics
NPI:1679897672
Name:SPECTRUM LOW VISION REHABILITATION INC
Entity Type:Organization
Organization Name:SPECTRUM LOW VISION REHABILITATION INC
Other - Org Name:SPECTRUM LOW VISION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SCAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:813-245-6635
Mailing Address - Street 1:10714 N WATERHOLE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6573
Mailing Address - Country:US
Mailing Address - Phone:813-245-6635
Mailing Address - Fax:
Practice Address - Street 1:10714 N WATERHOLE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6573
Practice Address - Country:US
Practice Address - Phone:813-245-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT5211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty