=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972210904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPOT ON THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2022
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 831 MCCASKILL ST
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-452-9014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 831 MCCASKILL ST
-----------------------------------------------------
City | CRESTVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32536-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-452-9014
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MRS. ELAINA BARROW-CARR
-----------------------------------------------------
Credential | OT/R
-----------------------------------------------------
Telephone | 903-452-9014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------