Individual
NICHOLAS SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
3570 RIPLEY EE-2, GATEWOOD, MO 63942-9034
(573) 255-3347
Mailing address
3570 RIPLEY EE-2, GATEWOOD, MO 63942-9034
(573) 255-3347
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
2018031484
MO
Other
Enumeration date
04/09/2019
Last updated
06/04/2024
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