MEDICARE: KEISHA-BOYD SPENCE OTA

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	224Z00000X	Occupational Therapy Assistant	211472	TX

General Provider Information

NPI Number	:	1881971273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEISHA-BOYD SPENCE OTA

Provider Business Mailing Address
First Line	:	1250 HAMPTON BLVD APT 537
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5368
Country	:	US
Telephone Number	:	954-588-1246
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 HAMPTON BLVD APT 537
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-5368
Country	:	US
Telephone Number	:	954-588-1246
Fax Number	:

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/14/2011

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