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General NPI Number Information
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NPI Number | 1760817308
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Entity Type | Organization
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Legal Business Name | SPECTRUM LOW VISION FLORIDA PLLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 10201 TRANQUIL LN
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City | ODESSA
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State | FL
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Zip | 33556-2512
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Country | US
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Telephone | 813-245-6635
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Fax | 888-959-1443
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Provider Business Mailing Address
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Address Line | 10201 TRANQUIL LN
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City | ODESSA
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State | FL
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Zip | 33556-2512
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Country | US
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Telephone | 813-245-6635
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Fax | 888-959-1443
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL THOMAS SCAGLIONE
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Credential | OTR
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Telephone | 813-245-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT5211
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License Number State | FL
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