Provider Demographics
NPI:1578904983
Name:SPARKS, MORGAN RENE MAY (MT-BC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RENE MAY
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:JASONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47438-1505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:JASONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47438-1505
Practice Address - Country:US
Practice Address - Phone:812-798-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist