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General NPI Number Information
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NPI Number | 1639622954
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Entity Type | Individual
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Provider Name | STEVEN SILVERSPARRE MS, SCAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 935 ONE LANDON LOOP
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City | CONWAY
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State | SC
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Zip | 29526
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Country | US
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Telephone | 843-349-2768
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261954
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City | CONWAY
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State | SC
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Zip | 29528-6054
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Country | US
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Telephone | 843-349-2768
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1624
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License Number State | SC
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