Individual
MRS. LINDSAY R SPARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1709 SOUTH MAIN STREET, BROKEN ARROW, OK 74012
(918) 258-9125
Mailing address
1709 SOUTH MAIN STREET, BROKEN ARROW, OK 74012
(918) 258-9125
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
PTA- 225200000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1690
LICENSE
OK
Enumeration date
11/21/2012
Last updated
11/21/2012
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