Provider Demographics
NPI:1124622568
Name:SPARK PATH THERAPY LLC
Entity type:Organization
Organization Name:SPARK PATH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:770-618-9200
Mailing Address - Street 1:27 FROST LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-4349
Mailing Address - Country:US
Mailing Address - Phone:770-618-9200
Mailing Address - Fax:770-618-9300
Practice Address - Street 1:27 FROST LN
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-4349
Practice Address - Country:US
Practice Address - Phone:770-618-9200
Practice Address - Fax:770-618-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty