MEDICARE: ANDREA CLAUDINE SPENCER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173C00000X	Reflexologist	MT3838	ME
2	174400000X	Specialist	MT3838	ME

General Provider Information

NPI Number	:	1043449390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CLAUDINE SPENCER LMT

Provider Business Mailing Address
First Line	:	19 SOUTH ST
Second Line	:	SUITE 6
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:	207-252-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 SOUTH ST
Second Line	:	SUITE 6
City	:	PORTLAND
State	:	ME
Zip	:	04101-3963
Country	:	US
Telephone Number	:	207-252-8060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	07/08/2009

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