Provider Demographics
NPI:1851435796
Name:SPENCER, BRANDI RAE (ATC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RAE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 DUTCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-1200
Mailing Address - Country:US
Mailing Address - Phone:304-388-4900
Mailing Address - Fax:
Practice Address - Street 1:200 TRACY WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1258
Practice Address - Country:US
Practice Address - Phone:304-388-4900
Practice Address - Fax:304-388-4910
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer