Provider Demographics
NPI:1962751578
Name:SPENCER, TANEA (MOTRL)
Entity type:Individual
Prefix:
First Name:TANEA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 NORMAN DR.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227
Mailing Address - Country:US
Mailing Address - Phone:614-501-9223
Mailing Address - Fax:
Practice Address - Street 1:1183 NORMAN DR.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227
Practice Address - Country:US
Practice Address - Phone:614-501-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist