Healthcare Provider Details

I. General information

NPI: 1831031764
Provider Name (Legal Business Name): SPENCER NICHOLS RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12331 E CORNELL AVE
AURORA CO
80014-3323
US

IV. Provider business mailing address

12331 E CORNELL AVE
AURORA CO
80014-3323
US

V. Phone/Fax

Practice location:
  • Phone: 720-507-5226
  • Fax:
Mailing address:
  • Phone: 720-507-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-390597
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: