Provider Demographics
NPI:1891257366
Name:SPITZENBERGER, NICOLE LEAH
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEAH
Last Name:SPITZENBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19226 COUNTRY VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3055
Mailing Address - Country:US
Mailing Address - Phone:281-787-9915
Mailing Address - Fax:
Practice Address - Street 1:19226 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3055
Practice Address - Country:US
Practice Address - Phone:281-787-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX739669OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES