Basic Information
| Provider Information | |||||||||
| NPI: | 1497988406 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPARKS | ||||||||
| FirstName: | LINDSI | ||||||||
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| Credential: | MOT, OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1492 W ANTELOPE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018258091 | ||||||||
| FaxNumber: | 8018258142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1492 W ANTELOPE DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018258091 | ||||||||
| FaxNumber: | 8018258142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2009 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 4860774-4201 | UT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.