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General NPI Number Information
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NPI Number | 1356690762
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Entity Type | Individual
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Provider Name | WILLIAM CAREY SPENCER
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Gender | Male
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 2200 STONY BROOK DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-4016
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Country | US
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Telephone | 502-495-6240
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Fax |
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Provider Business Mailing Address
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Address Line | 9611 GLENAWYN CIR
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City | JEFFERSONTOWN
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State | KY
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Zip | 40299-2901
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Country | US
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Telephone | 502-712-1773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | A5441
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License Number State | KY
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