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General NPI Number Information
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NPI Number | 1053942110
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Entity Type | Organization
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Legal Business Name | INNERSPARKS,LLC
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 1468 N HIGH POINT RD
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City | MIDDLETON
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State | WI
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Zip | 53562-3683
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Country | US
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Telephone | 608-836-0305
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Fax |
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Provider Business Mailing Address
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Address Line | 6310 STONEFIELD RD
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City | MIDDLETON
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State | WI
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Zip | 53562-3839
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Country | US
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Telephone | 608-516-7087
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA KIVOLOWITZ
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Credential | OT/L
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Telephone | 608-836-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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