Individual
JORDAN NICOLE SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
(903) 939-7754
Mailing address
PO BOX 130189, TYLER, TX 75713-0189
(903) 939-7500
(903) 939-7754
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210115
TX
Other
Enumeration date
01/04/2012
Last updated
01/04/2012
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