Healthcare Provider Details

I. General information

NPI: 1194387498
Provider Name (Legal Business Name): SPOT FOR SPEECH AND OCCUPATIONAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 COLUMBIA 100 PKWY STE 4
COLUMBIA MD
21045-2361
US

IV. Provider business mailing address

8815 COLUMBIA 100 PKWY STE 4
COLUMBIA MD
21045-2361
US

V. Phone/Fax

Practice location:
  • Phone: 877-776-8502
  • Fax:
Mailing address:
  • Phone: 877-776-8502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ORELLANA
Title or Position: PRESIDENT
Credential:
Phone: 877-776-8502