Provider Demographics
NPI:1144459405
Name:SPILLSON, JOSEPH A (OTR/L)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:SPILLSON
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SOUTHLAND DR
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2244
Mailing Address - Country:US
Mailing Address - Phone:304-367-7375
Mailing Address - Fax:
Practice Address - Street 1:51 SOUTHLAND DR
Practice Address - Street 2:SUITE 2400
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2244
Practice Address - Country:US
Practice Address - Phone:304-367-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV365225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist