Provider Demographics
NPI:1609359736
Name:MIND Y SPARKER CO
Entity Type:Organization
Organization Name:MIND Y SPARKER CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-559-1971
Mailing Address - Street 1:443 BOATWRIGHT DR
Mailing Address - Street 2:
Mailing Address - City:EASTPOINT
Mailing Address - State:FL
Mailing Address - Zip Code:32328-3445
Mailing Address - Country:US
Mailing Address - Phone:772-559-1971
Mailing Address - Fax:
Practice Address - Street 1:443 BOATWRIGHT DR
Practice Address - Street 2:
Practice Address - City:EASTPOINT
Practice Address - State:FL
Practice Address - Zip Code:32328-3445
Practice Address - Country:US
Practice Address - Phone:772-559-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty