Provider Demographics
NPI:1568792307
Name:SPETTS, ANGELA M (MS, ATC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:SPETTS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHESTNUT ST
Mailing Address - Street 2:#1
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 MIDDLE SETTLEMENT RD STE 102
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5332
Practice Address - Country:US
Practice Address - Phone:315-735-4496
Practice Address - Fax:315-624-9213
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001637-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer