MEDICARE: DORREY SPROATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1023658572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORREY SPROATT

Provider Business Mailing Address
First Line	:	417 N GENESEE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3656
Country	:	US
Telephone Number	:	818-489-5778
Fax Number	:

Provider Business Practice Location Address
First Line	:	3637 MOTOR AVE STE 280
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4884
Country	:	US
Telephone Number	:	323-285-1128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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Directions to “ DORREY SPROATT ” Practice Location

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