Individual
CHRISTINE LOUISE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
630 N FODALE AVE, SOUTHPORT, NC 28461-3538
(910) 457-0830
Mailing address
630 N FODALE AVE, SOUTHPORT, NC 28461-3538
(910) 457-0830
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
31002164A
IN
225X00000X
Occupational Therapist
Primary
6146
NC
225XG0600X
Gerontology Occupational Therapist
31002164A
IN
225XG0600X
Gerontology Occupational Therapist
6146
NC
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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