Healthcare Provider Details

I. General information

NPI: 1740816297
Provider Name (Legal Business Name): ALLISON SPARKS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4619 N RAVENSWOOD AVE STE 300
CHICAGO IL
60640-4579
US

IV. Provider business mailing address

4619 N RAVENSWOOD AVE STE 300
CHICAGO IL
60640-4579
US

V. Phone/Fax

Practice location:
  • Phone: 630-677-3728
  • Fax:
Mailing address:
  • Phone: 630-677-3728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056013481
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: