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General NPI Number Information
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NPI Number | 1992470546
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Entity Type | Organization
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Legal Business Name | SUCCESS ON THE SPECTRUM PPCC INC
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Dates
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Enumeration Date | 08/14/2021
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 5816 ASHLEYANNE CIR STE 400
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1613
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Country | US
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Telephone | 940-692-0165
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Fax |
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Provider Business Mailing Address
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Address Line | 4400 CALL FIELD RD
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2446
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Country | US
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Telephone | 940-692-0165
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ALICE HUPP
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Credential |
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Telephone | 940-642-6715
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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