1013035286 NPI number — MRS. DANIELLE NICOLE SPENCER ATC

Table of content: MRS. DANIELLE NICOLE SPENCER ATC (NPI 1013035286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013035286 NPI number — MRS. DANIELLE NICOLE SPENCER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPENCER
Provider First Name:
DANIELLE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013035286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3075 ADDISON NEW CARLISLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CARLISLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45344-7513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-846-0671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3490 FAR HILLS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KETTERING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45429-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-395-3920
Provider Business Practice Location Address Fax Number:
937-395-3950
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT1731 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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