Provider Demographics
NPI:1912649344
Name:SPARKS, TERRY L II (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:SPARKS
Suffix:II
Gender:M
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 WHITLEY CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1160
Mailing Address - Country:US
Mailing Address - Phone:513-614-4903
Mailing Address - Fax:
Practice Address - Street 1:2958 WHITLEY CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1160
Practice Address - Country:US
Practice Address - Phone:513-614-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker