Provider Demographics
NPI:1154711463
Name:SPECTRUM OT SERVICES, INC.
Entity type:Organization
Organization Name:SPECTRUM OT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:207-333-3678
Mailing Address - Street 1:PO BOX 2303
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-2303
Mailing Address - Country:US
Mailing Address - Phone:207-333-3678
Mailing Address - Fax:207-333-3679
Practice Address - Street 1:475 PLEASANT ST
Practice Address - Street 2:UNIT 23
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3951
Practice Address - Country:US
Practice Address - Phone:207-333-3678
Practice Address - Fax:207-333-3679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO2975261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities