Provider Demographics
NPI:1912142415
Name:SPARAGOWSKI, NANCY DIANE YOHE
Entity Type:Individual
Prefix:MRS
First Name:NANCY DIANE
Middle Name:YOHE
Last Name:SPARAGOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:DIANE
Other - Last Name:YOHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 WHEELER PL
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-7010
Mailing Address - Country:US
Mailing Address - Phone:850-682-8388
Mailing Address - Fax:
Practice Address - Street 1:4100 S FERDON BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-5252
Practice Address - Country:US
Practice Address - Phone:850-682-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA 3647224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant