Individual
TRACEY LYNN SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1701 EAGLES CREST AVE, F-6, DAVENPORT, IA 52804-5083
(309) 635-0454
Mailing address
1701 EAGLES CREST AVENUE, F-6, DAVENPORT, IL 52804-3652
(309) 635-0454
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
IL
Other
Enumeration date
04/01/2008
Last updated
04/01/2008
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