Healthcare Provider Details

I. General information

NPI: 1881377737
Provider Name (Legal Business Name): SPARROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 W MAIN ST
SOMERVILLE NJ
08876-2204
US

IV. Provider business mailing address

167 MOUNT HOREB RD
WARREN NJ
07059-5628
US

V. Phone/Fax

Practice location:
  • Phone: 732-595-7212
  • Fax:
Mailing address:
  • Phone: 908-524-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALISON JOY HAGGAN
Title or Position: OWNER
Credential: MS, OTR/L
Phone: 908-524-8152