Provider Demographics
NPI:1508387556
Name:SPOONER, ALEXANDRIA MARIE (CMT)
Entity Type:Individual
Prefix:MS
First Name:ALEXANDRIA
Middle Name:MARIE
Last Name:SPOONER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 ROYCE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ORWELL
Mailing Address - State:VT
Mailing Address - Zip Code:05760-9771
Mailing Address - Country:US
Mailing Address - Phone:802-349-7907
Mailing Address - Fax:
Practice Address - Street 1:213 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8986
Practice Address - Country:US
Practice Address - Phone:802-349-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist