Provider Demographics
NPI:1720102890
Name:SPAULDING, ROBERT L (CNMT, LMT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:CNMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 FULTON DR NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2819
Mailing Address - Country:US
Mailing Address - Phone:330-492-6655
Mailing Address - Fax:330-492-6655
Practice Address - Street 1:4105 FULTON DR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2819
Practice Address - Country:US
Practice Address - Phone:330-492-6655
Practice Address - Fax:330-492-6655
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist