MEDICARE: SPECTRUM THERAPY SERVICES

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	235Z00000X	Speech-Language Pathologist	SA 7231	FL
2	235Z00000X	Speech-Language Pathologist	SA 8125	FL
3	225X00000X	Occupational Therapist	OT 11987	FL
4	225X00000X	Occupational Therapist	OT 9969	FL
5	225X00000X	Occupational Therapist	OT 9973	FL
6	225XP0200X	Pediatric Occupational Therapist	OT11299	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194770081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM THERAPY SERVICES

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST
Second Line	:	SUITE 302
City	:	COOPER CITY
State	:	FL
Zip	:	33026-1505
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST
Second Line	:	SUITE 302
City	:	COOPER CITY
State	:	FL
Zip	:	33026-1505
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. TYLER HARROLD
Credential	:
Telephone Number	:	954-499-1125

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/20/2007

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Directions to “SPECTRUM THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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