MEDICARE: JANICE A SPEARS PTA

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	174400000X	Specialist	AT 2600	CA

General Provider Information

NPI Number	:	1508140005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE A SPEARS PTA

Provider Business Mailing Address
First Line	:	1840 W EMELITA AVE
Second Line	:	#1144
City	:	MESA
State	:	AZ
Zip	:	85202-4035
Country	:	US
Telephone Number	:	562-484-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 W EMELITA AVE
Second Line	:	#1144
City	:	MESA
State	:	AZ
Zip	:	85202-4035
Country	:	US
Telephone Number	:	562-484-4600
Fax Number	:

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

Provider Enumeration Date	:	10/03/2011
Last Update Date	:	10/03/2011

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Directions to “ JANICE A SPEARS PTA” Practice Location

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