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NPI Code Detail

MEDICARE: MRS. JILL MARIA SPARKS

MEDICARE: MRS. JILL MARIA SPARKS
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
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1952584963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILL MARIA SPARKS
Provider Business Mailing Address
First Line : 148 WARREN ST
Second Line :
City : LOWELL
State : MA
Zip : 01852-2208
Country : US
Telephone Number : 978-452-1736
Fax Number :
Provider Business Practice Location Address
First Line : 148 WARREN ST
Second Line :
City : LOWELL
State : MA
Zip : 01852-2208
Country : US
Telephone Number : 978-452-1736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2007
Last Update Date : 05/11/2018

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Directions to “ MRS. JILL MARIA SPARKS ” Practice Location

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