Healthcare Provider Details

I. General information

NPI: 1073857504
Provider Name (Legal Business Name): MRS. HANNAH MICHELLE SPARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS HANNAH MICHELLE MUNCHER

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 L SHIPP RD
EMPIRE AL
35063-6236
US

IV. Provider business mailing address

170 L SHIPP RD
EMPIRE AL
35063-6236
US

V. Phone/Fax

Practice location:
  • Phone: 205-983-2034
  • Fax:
Mailing address:
  • Phone: 205-983-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3070
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: