Provider Demographics
NPI:1518635572
Name:SPARK REHAB
Entity Type:Organization
Organization Name:SPARK REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:MARY AVELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-966-7187
Mailing Address - Street 1:2001 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 1ST AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3624
Practice Address - Country:US
Practice Address - Phone:732-966-7187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty