Healthcare Provider Details

I. General information

NPI: 1902115967
Provider Name (Legal Business Name): SPECTRUM HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9026 WILL SEXTON RD
MILTON FL
32570-9302
US

IV. Provider business mailing address

9026 WILL SEXTON RD
MILTON FL
32570-9302
US

V. Phone/Fax

Practice location:
  • Phone: 850-957-4747
  • Fax:
Mailing address:
  • Phone: 850-957-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0838
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAURA LEANNE O'BRIEN
Title or Position: PRESIDENT
Credential:
Phone: 850-957-4747