Provider Demographics
NPI:1093908626
Name:SPENCER, COLETTE ELAINE (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:COLETTE
Middle Name:ELAINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 ANDREW CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-1896
Mailing Address - Country:US
Mailing Address - Phone:816-262-5956
Mailing Address - Fax:816-676-2766
Practice Address - Street 1:1105 STATE ST
Practice Address - Street 2:
Practice Address - City:MOUND CITY
Practice Address - State:MO
Practice Address - Zip Code:64470-7202
Practice Address - Country:US
Practice Address - Phone:816-262-5956
Practice Address - Fax:816-676-2766
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOOC002219OtherOCCUPATIONAL THERAPY LIC#