Healthcare Provider Details

I. General information

NPI: 1508258443
Provider Name (Legal Business Name): SPECTRUM CREATIVE ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MONROE AVE
ROCHESTER NY
14618-4624
US

IV. Provider business mailing address

3300 MONROE AVE
ROCHESTER NY
14618-4624
US

V. Phone/Fax

Practice location:
  • Phone: 585-383-1999
  • Fax:
Mailing address:
  • Phone: 585-383-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MEGAN RESIG
Title or Position: CO-FOUNDER/DIRECTOR/MUSIC THERAPIST
Credential: MT-BC
Phone: 585-383-1999