Provider Demographics
NPI:1992430805
Name:SPARKESGRIFFIN, CAMILLE NORAN
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NORAN
Last Name:SPARKESGRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 KAYLEIGH LYN LN
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-6062
Mailing Address - Country:US
Mailing Address - Phone:150-830-8059
Mailing Address - Fax:
Practice Address - Street 1:24 KAYLEIGH LYN LN
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-6062
Practice Address - Country:US
Practice Address - Phone:508-308-0596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8276225XP0200X
MA8276225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics