Healthcare Provider Details

I. General information

NPI: 1972210904
Provider Name (Legal Business Name): SPOT ON THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 MCCASKILL ST
CRESTVIEW FL
32536-2757
US

IV. Provider business mailing address

831 MCCASKILL ST
CRESTVIEW FL
32536-2757
US

V. Phone/Fax

Practice location:
  • Phone: 903-452-9014
  • Fax:
Mailing address:
  • Phone: 903-452-9014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINA BARROW-CARR
Title or Position: PRESIDENT/OWNER
Credential: OT/R
Phone: 903-452-9014