Provider Demographics
NPI:1679031306
Name:SPICONARDI, TARYN (LMT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:SPICONARDI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PAWCATUCK VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:RI
Mailing Address - Zip Code:02812-1010
Mailing Address - Country:US
Mailing Address - Phone:401-855-0841
Mailing Address - Fax:
Practice Address - Street 1:1136 MAIN ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02898-1074
Practice Address - Country:US
Practice Address - Phone:401-321-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02255225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist