Healthcare Provider Details

I. General information

NPI: 1194770081
Provider Name (Legal Business Name): SPECTRUM THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11011 SHERIDAN ST SUITE 302
COOPER CITY FL
33026-1505
US

IV. Provider business mailing address

11011 SHERIDAN ST SUITE 302
COOPER CITY FL
33026-1505
US

V. Phone/Fax

Practice location:
  • Phone: 954-499-1125
  • Fax: 954-499-1123
Mailing address:
  • Phone: 954-499-1125
  • Fax: 954-499-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 11987
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 9969
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT 9973
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11299
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 8125
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 7231
License Number StateFL

VIII. Authorized Official

Name: MR. TYLER HARROLD
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-499-1125