Provider Demographics
NPI:1932383098
Name:SPENCER, PATRICIA T (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:T
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WIGGINTON ROAD
Mailing Address - Street 2:
Mailing Address - City:FIELDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24089-3228
Mailing Address - Country:US
Mailing Address - Phone:276-681-6663
Mailing Address - Fax:
Practice Address - Street 1:240 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-4257
Practice Address - Country:US
Practice Address - Phone:276-629-1772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004527174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist