Provider Demographics
NPI:1700306727
Name:SPARKS, SARA (MOT, OTR)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:MOT, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK LN
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-8221
Mailing Address - Country:US
Mailing Address - Phone:682-472-9899
Mailing Address - Fax:
Practice Address - Street 1:3605 YUCCA DR STE 102
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2753
Practice Address - Country:US
Practice Address - Phone:682-472-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118340225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics