MEDICARE: MS. SARA SPARKS MOT, OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	118340	TX

General Provider Information

NPI Number	:	1700306727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARA SPARKS MOT, OTR

Provider Business Mailing Address
First Line	:	100 PARK LN
Second Line	:
City	:	DOUBLE OAK
State	:	TX
Zip	:	75077-8221
Country	:	US
Telephone Number	:	682-472-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 YUCCA DR STE 102
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2753
Country	:	US
Telephone Number	:	682-472-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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