MEDICARE: LAURIE JEANNE SPENCER CNMT

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1588809628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE JEANNE SPENCER CNMT

Provider Business Mailing Address
First Line	:	637 PINE DR
Second Line	:
City	:	GUFFEY
State	:	CO
Zip	:	80820-9660
Country	:	US
Telephone Number	:	719-641-1557
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 BURDETTE ST
Second Line	:	SUITE A
City	:	WOODLAND PARK
State	:	CO
Zip	:	80863-2435
Country	:	US
Telephone Number	:	719-641-1557
Fax Number	:

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

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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