Healthcare Provider Details

I. General information

NPI: 1609009042
Provider Name (Legal Business Name): FULL SPECTRUM HEALING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PANORAMA DR
DRIPPING SPRINGS TX
78620-2532
US

IV. Provider business mailing address

801 PANORAMA DR
DRIPPING SPRINGS TX
78620-2532
US

V. Phone/Fax

Practice location:
  • Phone: 512-538-5748
  • Fax:
Mailing address:
  • Phone: 512-538-5748
  • Fax: 512-382-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103532
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number103532
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112162
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number103532
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number112162
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number112162
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number103532
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number103532
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 11
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA M ANDERSON
Title or Position: CE
Credential: OTR
Phone: 512-538-5748