Provider Demographics
NPI:1861368227
Name:SPENGLER, KRISTIN (MT-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SPENGLER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 WOODLAKE DR APT 256
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-7100
Mailing Address - Country:US
Mailing Address - Phone:813-892-4926
Mailing Address - Fax:
Practice Address - Street 1:1475 WOODLAKE DR APT 256
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-7100
Practice Address - Country:US
Practice Address - Phone:813-892-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18796225A00000X
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty