Organization
OLIVE BRANCH NEURO THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNEMARIE SPARKS (DIRECTOR/OWNER)
(609) 670-8152
Entity
Organization
Contact information
Practice address
176 CHANCELLOR DR, DEPTFORD, NJ 08096
(609) 670-8152
(856) 494-1495
Mailing address
304 PARKVILLE STATION RD, MANTUA, NJ 08051-1621
(609) 670-8152
(856) 494-1495
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
—
—
224ZE0001X
Environmental Modification Occupational Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Enumeration date
02/20/2023
Last updated
09/05/2023
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