Provider Demographics
NPI:1194303503
Name:SPARKS, JAMES D (COTA/L)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:SPARKS
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 CAROLYN ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-6901
Mailing Address - Country:US
Mailing Address - Phone:330-307-3796
Mailing Address - Fax:
Practice Address - Street 1:103 N 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2343
Practice Address - Country:US
Practice Address - Phone:814-432-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant