Provider Demographics
NPI:1912038316
Name:SPEAR, CALVIN (OT)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:SPEAR
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 1:12001 SHELBYVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-3008
Mailing Address - Country:US
Mailing Address - Phone:502-244-5044
Mailing Address - Fax:502-244-5190
Practice Address - Street 1:12001 SHELBYVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-3008
Practice Address - Country:US
Practice Address - Phone:502-244-5044
Practice Address - Fax:502-244-5190
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2563225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000343514OtherANTHEM NUMBER
KY0988302Medicare ID - Type UnspecifiedMEDICARE NUMBER