Provider Demographics
NPI:1396901955
Name:SPERGIN, RANDALL SCOTT (MOT, OTR/L, CLT)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:SCOTT
Last Name:SPERGIN
Suffix:
Gender:M
Credentials:MOT, OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 LOCKWOOD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-5190
Mailing Address - Country:US
Mailing Address - Phone:931-232-9612
Mailing Address - Fax:
Practice Address - Street 1:133 LOCKWOOD HOLLOW RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-5190
Practice Address - Country:US
Practice Address - Phone:931-232-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist