National Provider Identifier
Johanna Glen Sparks, OT
Johanna Glen Sparks, OT is listed in the NPPES registry with a primary specialty of Occupational Therapist in Ithaca, NY and a listed phone number of (607) 592-3209.
Profile Overview
- NPI
- 1508015611
- Provider Type
- Individual
- Primary Specialty
- Occupational Therapist
- Enumeration Date
- September 12, 2008
- Last Updated
- September 12, 2008
Practice Location
- 1592 Mecklenburg RD
- Ithaca, NY 14850-9243
Phone: (607) 592-3209
Specialties
- Occupational Therapist (225X00000X)
Full Record
- NPI
- 1508015611
- Entity Type
- Individual
- Last Name
- Sparks
- First Name
- Johanna
- Middle Name
- Glen
- Credential
- OT
- Mailing Street Address
- 1592 Mecklenburg RD
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-9243
- Mailing Country
- US
- Mailing Phone
- (607) 592-3209
- Practice Street Address
- 1592 Mecklenburg RD
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-9243
- Practice Country
- US
- Practice Phone
- (607) 592-3209
- Enumeration Date
- September 12, 2008
- Last Updated
- September 12, 2008
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Occupational Therapist (225X00000X)