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General NPI Number Information
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NPI Number | 1538786843
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Entity Type | Organization
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Legal Business Name | SPARK PEDIATRIC OT, PLLC
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 29 E MAIN ST
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City | WESTPORT
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State | CT
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Zip | 06880-3770
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Country | US
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Telephone | 917-692-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 29 E MAIN ST
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City | WESTPORT
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State | CT
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Zip | 06880-3770
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Country | US
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Telephone | 917-692-9805
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN HELLMANN
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Credential | MA, OTR/L
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Telephone | 917-692-9805
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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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