Provider Demographics
NPI:1306377411
Name:SPENCER, KATHERINE TERRY
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:TERRY
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:TERRY
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:27700 SIDNEY DR
Mailing Address - Street 2:UNIT 204K
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3094
Mailing Address - Country:US
Mailing Address - Phone:216-312-6187
Mailing Address - Fax:216-465-2697
Practice Address - Street 1:27700 SIDNEY DR
Practice Address - Street 2:APT 204K
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3094
Practice Address - Country:US
Practice Address - Phone:216-312-6187
Practice Address - Fax:216-465-2697
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401924601216376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide