Provider Demographics
NPI:1073815510
Name:SPROUSE, CELENA
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:SPROUSE
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 1:6463 PROPRIETORS RD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3263
Mailing Address - Country:US
Mailing Address - Phone:614-578-2261
Mailing Address - Fax:
Practice Address - Street 1:6463 PROPRIETORS RD
Practice Address - Street 2:SUITE 3B
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3263
Practice Address - Country:US
Practice Address - Phone:614-578-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist