Provider Demographics
NPI:1740558162
Name:SPENCER, ADA S (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:S
Last Name:SPENCER
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 1:1080 KY 715
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:KY
Mailing Address - Zip Code:41365-8331
Mailing Address - Country:US
Mailing Address - Phone:606-362-7959
Mailing Address - Fax:
Practice Address - Street 1:22 DORSEY SPENCER RD.
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41360
Practice Address - Country:US
Practice Address - Phone:606-362-7959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-4051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist