Provider Demographics
NPI:1588097901
Name:SPARKMAN, KATHERINE BUZZA (MOT/L)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BUZZA
Last Name:SPARKMAN
Suffix:
Gender:F
Credentials:MOT/L
Other - Prefix:MRS
Other - First Name:KATIE
Other - Middle Name:BUZZA
Other - Last Name:SPARKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MOT/L
Mailing Address - Street 1:716 E BELLA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3009
Mailing Address - Country:US
Mailing Address - Phone:863-683-6504
Mailing Address - Fax:
Practice Address - Street 1:716 E BELLA VISTA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3009
Practice Address - Country:US
Practice Address - Phone:863-683-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9448225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics