Provider Demographics
NPI:1205062486
Name:SPARKS-KEENEY, TIFFANY JUNETTE (OT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JUNETTE
Last Name:SPARKS-KEENEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:JUNETTE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:STE 160
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4934
Mailing Address - Country:US
Mailing Address - Phone:425-656-4215
Mailing Address - Fax:425-656-5075
Practice Address - Street 1:3600 LIND AVE SW
Practice Address - Street 2:STE 160
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4934
Practice Address - Country:US
Practice Address - Phone:425-656-4215
Practice Address - Fax:425-656-5075
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60042449225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist