Provider Demographics
NPI:1407392335
Name:SPICER, CAROL LYNN (OTR)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:SPICER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1849
Mailing Address - Country:US
Mailing Address - Phone:303-579-4050
Mailing Address - Fax:
Practice Address - Street 1:1075 EMERALD ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1849
Practice Address - Country:US
Practice Address - Phone:303-579-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001801225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOT.0001801OtherDORA