Individual
FABIAN T SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 966-9830
Mailing address
PO BOX 160, PENDLETON, OR 97801-0160
(154) 196-6983
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000104602
OR
Other
Enumeration date
03/26/2021
Last updated
03/30/2021
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