MEDICARE: TRACY SPIGELMAN PHD, AT

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	390200000X	Student in an Organized Health Care Education/Training Program	AT374	KY

General Provider Information

NPI Number	:	1700238649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY SPIGELMAN PHD, AT

Provider Business Mailing Address
First Line	:	333 PLEASANT POINTE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4483
Country	:	US
Telephone Number	:	215-694-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 PLEASANT POINTE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4483
Country	:	US
Telephone Number	:	215-694-7287
Fax Number	:

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

Provider Enumeration Date	:	07/04/2016
Last Update Date	:	07/04/2016

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