Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 01493 | TN |
NPI | 1609090265 |
---|---|
Provider Name | Ms. Sheila Marie Sparks |
First Address | Knoxville, TN 37931-4219 |
Second Address | Lake City, TN 37769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |