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General NPI Number Information
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NPI Number | 1760600308
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Entity Type | Individual
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Provider Name | KIMYUATTA A SPENCER RPT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 216 1ST ST S
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City | REFORM
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State | AL
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Zip | 35481
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Country | US
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Telephone | 205-375-9255
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Fax | 205-375-9245
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Provider Business Mailing Address
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Address Line | 11118 ALFORD AVE
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City | NORTHPORT
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State | AL
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Zip | 35475-4530
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Country | US
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Telephone | 205-330-8526
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PTH3586
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License Number State | AL
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