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Individual

STEPHANIE SPARKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C, ATC, MED, MSPS

Contact information

Practice address
500 LONDON AVE, MARYSVILLE, OH 43040-5512
(937) 644-6115
Mailing address
11341 LAKE DR, LAKEVIEW, OH 43331-9717
(614) 205-2396

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT.003403
OH
363A00000X
Physician Assistant
Primary
50.004293
OH

Other

Enumeration date
02/17/2015
Last updated
09/22/2020
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