MEDICARE: FULL SPECTURM THERAPY INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225200000X	Physical Therapy Assistant
3	225X00000X	Occupational Therapist
4	235Z00000X	Speech-Language Pathologist
5	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538486683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL SPECTURM THERAPY INC

Provider Business Mailing Address
First Line	:	5605 MILTON RANCH ROAD
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-5124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5605 MILTON RANCH ROAD
Second Line	:
City	:	SHINGLE SPRINGS
State	:	CA
Zip	:	95682-5124
Country	:	US
Telephone Number	:	530-409-4941
Fax Number	:	916-200-0430

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DENNIS LACALLE
Credential	:
Telephone Number	:	530-409-4941

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	04/29/2010

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