Provider Demographics
NPI:1912132358
Name:SPECTRUM THERAPY CENTER, CORP.
Entity Type:Organization
Organization Name:SPECTRUM THERAPY CENTER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSUN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:405-285-6765
Mailing Address - Street 1:301 S BOULEVARD ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3878
Mailing Address - Country:US
Mailing Address - Phone:405-285-6765
Mailing Address - Fax:405-285-5403
Practice Address - Street 1:301 S BOULEVARD ST
Practice Address - Street 2:SUITE 126
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3878
Practice Address - Country:US
Practice Address - Phone:405-285-6765
Practice Address - Fax:405-285-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty