Provider Demographics
NPI:1780708222
Name:SPENCER, TAMMIE ELAINE
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:ELAINE
Last Name:SPENCER
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 1:1607 NORMAL ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:64683-1967
Mailing Address - Country:US
Mailing Address - Phone:660-359-2228
Mailing Address - Fax:660-359-3995
Practice Address - Street 1:TRENTON R-IX SCHOOLS
Practice Address - Street 2:1607 NORMAL ST
Practice Address - City:TRENTON
Practice Address - State:MO
Practice Address - Zip Code:64683-1967
Practice Address - Country:US
Practice Address - Phone:660-359-2228
Practice Address - Fax:660-359-3995
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475931713Medicaid