Provider Demographics
NPI:1639964349
Name:SPARKS, HALLIE DENAE (OTR/L)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:DENAE
Last Name:SPARKS
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2193 STATE HIGHWAY 209
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8017
Mailing Address - Country:US
Mailing Address - Phone:606-316-1895
Mailing Address - Fax:
Practice Address - Street 1:115 MILLS ST
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-6800
Practice Address - Country:US
Practice Address - Phone:606-225-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY298824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist