MEDICARE: LORI LYNN SPENCER LMT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	227-003030	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	227-003030	OTHER	IL	IL LICENSE

General Provider Information

NPI Number	:	1659547164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LYNN SPENCER LMT

Provider Business Mailing Address
First Line	:	141 W JACKSON BLVD
Second Line	:	SUITE A 20
City	:	CHICAGO
State	:	IL
Zip	:	60604-2929
Country	:	US
Telephone Number	:	312-636-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 W JACKSON BLVD
Second Line	:	SUITE A 20
City	:	CHICAGO
State	:	IL
Zip	:	60604-2929
Country	:	US
Telephone Number	:	312-636-0440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/12/2009

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Directions to “ LORI LYNN SPENCER LMT” Practice Location

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