Provider Demographics
NPI:1891806519
Name:SPANN, JOANN MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:MARIE
Last Name:SPANN
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 1:52 GUITAR DR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63389-1009
Mailing Address - Country:US
Mailing Address - Phone:636-566-8856
Mailing Address - Fax:
Practice Address - Street 1:2982 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7861
Practice Address - Country:US
Practice Address - Phone:636-978-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer