Provider Demographics
NPI:1104717958
Name:SPENCER, JOSH
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:SPENCER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 S 36TH TER
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8880
Mailing Address - Country:US
Mailing Address - Phone:479-420-7846
Mailing Address - Fax:
Practice Address - Street 1:1380 N HERITAGE LN
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2136
Practice Address - Country:US
Practice Address - Phone:918-456-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5274225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist