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General NPI Number Information
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NPI Number | 1700798634
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Entity Type | Organization
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Legal Business Name | FULLSPECTRUMABA
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 8001 BEATY GROVE DR
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City | TAMPA
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State | FL
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Zip | 33626-1602
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Country | US
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Telephone | 813-926-5454
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Fax |
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Provider Business Mailing Address
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Address Line | 41 ROSS HALL RD
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City | PRENTISS
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State | MS
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Zip | 39474-2999
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR TECH
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Name | KATRINA CHEATHAM
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Credential |
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Telephone | 601-325-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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