MEDICARE: JONATHAN M SPENCER

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	372500000X	Chore Provider

General Provider Information

NPI Number	:	1801234307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN M SPENCER

Provider Business Mailing Address
First Line	:	4523 SARATOGA PL
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-3781
Country	:	US
Telephone Number	:	937-823-3434
Fax Number	:	937-242-6015

Provider Business Practice Location Address
First Line	:	4523 SARATOGA PL
Second Line	:
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-3781
Country	:	US
Telephone Number	:	937-823-3434
Fax Number	:	937-242-6015

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

Provider Enumeration Date	:	06/06/2013
Last Update Date	:	06/06/2013

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Directions to “ JONATHAN M SPENCER ” Practice Location

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