=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083942569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH SPEAR MT-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2009
-----------------------------------------------------
Last Update Date | 11/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 WELBY WAY STE 5
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-325-6301
-----------------------------------------------------
Fax | 850-325-6302
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1915 WELBY WAY STE 5
-----------------------------------------------------
City | TALLAHASSEE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32308-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-325-6301
-----------------------------------------------------
Fax | 850-325-6302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225A00000X
-----------------------------------------------------
Taxonomy Name | Music Therapist
-----------------------------------------------------
License Number | 08193
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------