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NPI Code Detail

MEDICARE: SPENCER EDWARD FURLICH MS, AT, ATC, NREMT

MEDICARE: SPENCER EDWARD FURLICH MS, AT, ATC, NREMT
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
12255A2300XAthletic Trainer1588295513OH

General Provider Information

NPI Number : 1588295513
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER EDWARD FURLICH MS, AT, ATC, NREMT
Provider Business Mailing Address
First Line : 2735 DERBYSHIRE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44106-3342
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2735 DERBYSHIRE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44106-3342
Country : US
Telephone Number : 216-301-8307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2020
Last Update Date : 02/05/2023

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