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Individual
TYLER SPICER
Active
Individual
TYLER SPICER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EMT
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25461
CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CT
Enumeration date
04/20/2020
Last updated
05/03/2020
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