Provider Demographics
NPI:1891058004
Name:SMITH, SPENCER J (CPO, LOP)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:CPO, LOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SPRING HILL DR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2388
Mailing Address - Country:US
Mailing Address - Phone:281-296-8999
Mailing Address - Fax:281-296-8989
Practice Address - Street 1:230 SPRING HILL DR
Practice Address - Street 2:SUITE 335
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2388
Practice Address - Country:US
Practice Address - Phone:281-296-8999
Practice Address - Fax:281-296-8989
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1480222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist