Provider Demographics
NPI:1699097980
Name:SPACIL, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SPACIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236 NIGHT PARROT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3805
Mailing Address - Country:US
Mailing Address - Phone:702-375-2336
Mailing Address - Fax:702-897-0905
Practice Address - Street 1:2236 NIGHT PARROT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3805
Practice Address - Country:US
Practice Address - Phone:702-375-2336
Practice Address - Fax:702-897-0905
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist