Provider Demographics
NPI:1598395964
Name:SPARKS, ANGELA MARIA (COTA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:SPARKS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GILMAN PLZ
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3561
Mailing Address - Country:US
Mailing Address - Phone:207-990-0162
Mailing Address - Fax:
Practice Address - Street 1:28 GILMAN PLZ
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3561
Practice Address - Country:US
Practice Address - Phone:207-990-0162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant