Provider Demographics
NPI:1245976166
Name:SPEARS, TAVON LAMAR (ATC)
Entity type:Individual
Prefix:MR
First Name:TAVON
Middle Name:LAMAR
Last Name:SPEARS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 TANGLEROSE CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7843
Mailing Address - Country:US
Mailing Address - Phone:469-765-7119
Mailing Address - Fax:
Practice Address - Street 1:1501 TANGLEROSE CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7843
Practice Address - Country:US
Practice Address - Phone:469-765-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000506772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty