Provider Demographics
NPI:1053836767
Name:SPEICHER, MERCEDEZ MARIE (ATC)
Entity type:Individual
Prefix:
First Name:MERCEDEZ
Middle Name:MARIE
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 CHISHOLM RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6351
Mailing Address - Country:US
Mailing Address - Phone:319-239-4368
Mailing Address - Fax:
Practice Address - Street 1:1 HARRISON PLZ
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35632-0002
Practice Address - Country:US
Practice Address - Phone:256-765-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1992207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine