Provider Demographics
NPI:1114247194
Name:SPRATLEY, LARITA
Entity Type:Individual
Prefix:
First Name:LARITA
Middle Name:
Last Name:SPRATLEY
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 1:828 BOLD ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3904
Mailing Address - Country:US
Mailing Address - Phone:757-202-0647
Mailing Address - Fax:757-673-0045
Practice Address - Street 1:828 BOLD ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3904
Practice Address - Country:US
Practice Address - Phone:757-202-0647
Practice Address - Fax:757-673-0045
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
VAT60606904343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Yes253Z00000XAgenciesIn Home Supportive Care