=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376007849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN M SPICER LP, CP, COA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2019
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11237 FAIROAKS RD NE STE B
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44612-8767
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-595-1010
-----------------------------------------------------
Fax | 330-595-1051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11736 STRASBURG BOLIVAR RD NW APT 1
-----------------------------------------------------
City | BOLIVAR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44612-8471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-904-9156
-----------------------------------------------------
Fax | 330-595-1051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | LP.00116
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225000000X
-----------------------------------------------------
Taxonomy Name | Orthotic Fitter
-----------------------------------------------------
License Number | COA00304
-----------------------------------------------------
License Number State |
-----------------------------------------------------