Provider Demographics
NPI:1174734651
Name:SPURGEON, ALTON (OTR,L)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:
Last Name:SPURGEON
Suffix:
Gender:M
Credentials:OTR,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 CHEVIGNY ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2035
Mailing Address - Country:US
Mailing Address - Phone:907-248-5641
Mailing Address - Fax:
Practice Address - Street 1:6709 CHEVIGNY ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2035
Practice Address - Country:US
Practice Address - Phone:907-248-5641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK490225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist