Healthcare Provider Details

I. General information

NPI: 1679983613
Provider Name (Legal Business Name): SPARC OCCUPATIONAL AND PHYSICAL THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BLOSSOM RD SUITE 308
ROCHESTER NY
14610-1825
US

IV. Provider business mailing address

595 BLOSSOM RD SUITE 308
ROCHESTER NY
14610-1825
US

V. Phone/Fax

Practice location:
  • Phone: 585-355-4071
  • Fax: 585-355-4071
Mailing address:
  • Phone: 585-355-4071
  • Fax: 585-355-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number003402
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number012187
License Number StateNY

VIII. Authorized Official

Name: MS. MARGARET M ORLANDO
Title or Position: OWNER
Credential: OTR
Phone: 585-748-5689