Provider Demographics
NPI:1134943392
Name:SPECTRUM THERAPY SERVICES
Entity type:Organization
Organization Name:SPECTRUM THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:804-205-0355
Mailing Address - Street 1:1825 BLACKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAIDENS
Mailing Address - State:VA
Mailing Address - Zip Code:23102-2526
Mailing Address - Country:US
Mailing Address - Phone:804-205-0355
Mailing Address - Fax:
Practice Address - Street 1:1825 BLACKWOOD DR
Practice Address - Street 2:
Practice Address - City:MAIDENS
Practice Address - State:VA
Practice Address - Zip Code:23102-2526
Practice Address - Country:US
Practice Address - Phone:804-205-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty