Organization
INNERSPARKS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA KIVOLOWITZ OT/L (OWNER)
(608) 836-0305
Entity
Organization
Contact information
Practice address
1468 N HIGH POINT RD, MIDDLETON, WI 53562-3683
(608) 836-0305
Mailing address
6310 STONEFIELD RD, MIDDLETON, WI 53562-3839
(608) 516-7087
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26-1173
STATE LICENSE
WI
Enumeration date
01/28/2020
Last updated
01/28/2020
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