Provider Demographics
| NPI: | 1275255093 |
|---|---|
| Name: | FULL SPECTRUM HEALING LLC |
| Entity type: | Organization |
| Organization Name: | FULL SPECTRUM HEALING LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | TINA |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | ANDERSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OTR |
| Authorized Official - Phone: | 512-538-5748 |
| Mailing Address - Street 1: | 166 HARGRAVES DR. |
| Mailing Address - Street 2: | C-400-542 |
| Mailing Address - City: | AUSTIN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78737 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 737-204-8790 |
| Mailing Address - Fax: | 877-839-2838 |
| Practice Address - Street 1: | 13805 ANN PL |
| Practice Address - Street 2: | |
| Practice Address - City: | AUSTIN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78728-7702 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 737-204-8790 |
| Practice Address - Fax: | 877-839-2838 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-09-19 |
| Last Update Date: | 2022-09-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225XH1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Human Factors | Group - Multi-Specialty |
| No | 225XE0001X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Environmental Modification | Group - Multi-Specialty |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
| No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
| No | 225XM0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Mental Health | Group - Multi-Specialty |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
