MEDICARE: TERESA ANN SPARKS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	347C00000X	Private Vehicle
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1710731740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN SPARKS

Provider Business Mailing Address
First Line	:	161 CHERRY HILL RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2127
Country	:	US
Telephone Number	:	567-303-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 CHERRY HILL RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2127
Country	:	US
Telephone Number	:	567-303-2335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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