Provider Demographics
NPI:1568159804
Name:SPOLTMAN, TERI JO
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:JO
Last Name:SPOLTMAN
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 1:2571 CLUNE STUCKE RD
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9795
Mailing Address - Country:US
Mailing Address - Phone:419-305-5962
Mailing Address - Fax:
Practice Address - Street 1:2571 CLUNE STUCKE RD
Practice Address - Street 2:
Practice Address - City:MARIA STEIN
Practice Address - State:OH
Practice Address - Zip Code:45860-9795
Practice Address - Country:US
Practice Address - Phone:419-305-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide