Healthcare Provider Details

I. General information

NPI: 1235447301
Provider Name (Legal Business Name): LI SPARKS L AU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 CINCINNATI DAYTON RD STE 104
WEST CHESTER OH
45069-7125
US

IV. Provider business mailing address

8833 CINCINNATI DAYTON RD STE 104
WEST CHESTER OH
45069-7125
US

V. Phone/Fax

Practice location:
  • Phone: 513-328-5600
  • Fax: 513-828-6928
Mailing address:
  • Phone: 513-328-5600
  • Fax: 513-828-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: