MEDICARE: PATRICIA T SPENCER OCCUPATIONAL THERAPI

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	174400000X	Specialist	0119004527	VA

General Provider Information

NPI Number	:	1932383098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA T SPENCER OCCUPATIONAL THERAPI

Provider Business Mailing Address
First Line	:	110 WIGGINTON ROAD
Second Line	:
City	:	FIELDALE
State	:	VA
Zip	:	24089-3228
Country	:	US
Telephone Number	:	276-681-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4257
Country	:	US
Telephone Number	:	276-629-1772
Fax Number	:

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

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	02/18/2010

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