Provider Demographics
NPI:1043449390
Name:SPENCER, ANDREA CLAUDINE (LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CLAUDINE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SOUTH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3963
Mailing Address - Country:US
Mailing Address - Phone:207-252-8060
Mailing Address - Fax:
Practice Address - Street 1:19 SOUTH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3963
Practice Address - Country:US
Practice Address - Phone:207-252-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT3838173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173C00000XOther Service ProvidersReflexologist