Healthcare Provider Details

I. General information

NPI: 1932704285
Provider Name (Legal Business Name): BARBARA SPURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4757 ROUTE 152 STE 2
LAVALETTE WV
25535-9638
US

IV. Provider business mailing address

4757 ROUTE 152 STE 2
LAVALETTE WV
25535-9638
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: