Provider Demographics
NPI:1780377796
Name:SPENCER, DEON MARCIA (OTR/L)
Entity type:Individual
Prefix:
First Name:DEON
Middle Name:MARCIA
Last Name:SPENCER
Suffix:
Gender:F
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 1:1130 NW 40TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6648
Mailing Address - Country:US
Mailing Address - Phone:954-496-1312
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 40TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-6648
Practice Address - Country:US
Practice Address - Phone:954-496-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12898225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist