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Individual

ELIZA HENNER SPARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
1456 MCLENDON DR STE B, DECATUR, GA 30033-1848
(404) 728-9766
Mailing address
1000 N CARTER RD, DECATUR, GA 30030-4703
(678) 315-8271

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT007149
GA

Other

Enumeration date
10/22/2018
Last updated
10/22/2018
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