Healthcare Provider Details

I. General information

NPI: 1699891929
Provider Name (Legal Business Name): MOUNTAIN AREA SPECTRUM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LOOP RD STE 9 SUITE 2B-3B
ARDEN NC
28704-8435
US

IV. Provider business mailing address

20 MALLORY MEADOWS CT
ARDEN NC
28704-8552
US

V. Phone/Fax

Practice location:
  • Phone: 828-687-1700
  • Fax: 828-687-1175
Mailing address:
  • Phone: 828-687-1700
  • Fax: 828-687-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTY DENISE DAVIS
Title or Position: VICE PRESIDENT
Credential: OT
Phone: 828-687-1700