Provider Demographics
NPI:1689364457
Name:SPELLMAN, TIER ANDREA (LMT)
Entity Type:Individual
Prefix:
First Name:TIER
Middle Name:ANDREA
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:TIER
Other - Middle Name:
Other - Last Name:ANDREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2401 E 6TH STREET STE 3037 #193
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702
Mailing Address - Country:US
Mailing Address - Phone:321-987-2389
Mailing Address - Fax:
Practice Address - Street 1:8600 W HIGHWAY 71 APT 1021
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8187
Practice Address - Country:US
Practice Address - Phone:321-987-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31090225700000X
DEMT0015108225700000X
FLMA63118225700000X
TXMT138182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist