MEDICARE: MS. ROSE MARIE SPECHT MT(ASCP)

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	246QM0706X	Medical Technologist	115447	WI

General Provider Information

NPI Number	:	1124432372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE MARIE SPECHT MT(ASCP)

Provider Business Mailing Address
First Line	:	2944 SHELLEY DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81503-2356
Country	:	US
Telephone Number	:	970-250-7984
Fax Number	:

Provider Business Practice Location Address
First Line	:	2944 SHELLEY DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81503-2356
Country	:	US
Telephone Number	:	970-250-7984
Fax Number	:

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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