MEDICARE: JORDAN SPIERING OTR

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	225X00000X	Occupational Therapist	081816	IA
2	225X00000X	Occupational Therapist	105101	MN

General Provider Information

NPI Number	:	1821459124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN SPIERING OTR

Provider Business Mailing Address
First Line	:	6951 KNOLLWOOD DR
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-4418
Country	:	US
Telephone Number	:	763-259-8123
Fax Number	:

Provider Business Practice Location Address
First Line	:	11001 W 120TH AVE STE 310
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3493
Country	:	US
Telephone Number	:	800-330-7711
Fax Number	:

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

Provider Enumeration Date	:	03/14/2016
Last Update Date	:	03/14/2016

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