Healthcare Provider Details

I. General information

NPI: 1588097901
Provider Name (Legal Business Name): KATHERINE BUZZA SPARKMAN MOT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIE BUZZA SPARKMAN MOT/L

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E BELLA VISTA ST
LAKELAND FL
33805-3009
US

IV. Provider business mailing address

716 E BELLA VISTA ST
LAKELAND FL
33805-3009
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-6504
  • Fax:
Mailing address:
  • Phone: 863-683-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT9448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: