Provider Demographics
NPI:1073857504
Name:SPARKS, HANNAH MICHELLE
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:MICHELLE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:MICHELLE
Other - Last Name:MUNCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:170 L SHIPP RD
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:AL
Mailing Address - Zip Code:35063-6236
Mailing Address - Country:US
Mailing Address - Phone:205-983-2034
Mailing Address - Fax:
Practice Address - Street 1:170 L SHIPP RD
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:AL
Practice Address - Zip Code:35063-6236
Practice Address - Country:US
Practice Address - Phone:205-983-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3070224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant