Provider Demographics
NPI:1104090422
Name:SEEFELDT, SPENCER STEVEN
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:STEVEN
Last Name:SEEFELDT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 STIMSON RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6445
Mailing Address - Country:US
Mailing Address - Phone:330-687-1230
Mailing Address - Fax:330-668-2158
Practice Address - Street 1:3819 STIMSON RD
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203-6445
Practice Address - Country:US
Practice Address - Phone:330-687-1230
Practice Address - Fax:330-668-2158
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2334727Medicaid