Healthcare Provider Details

I. General information

NPI: 1043418999
Provider Name (Legal Business Name): CHARMIL SPOONER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6TH & GIRARD ST. NW
WASHINGTON DC
20059
US

IV. Provider business mailing address

4310 R ST
CAPITOL HEIGHTS MD
20743-6710
US

V. Phone/Fax

Practice location:
  • Phone: 202-806-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: