Provider Demographics
NPI:1588348288
Name:SPARKS, ANDREA MICHELLE (RRT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:SPARKS
Suffix:
Gender:F
Credentials:RRT
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Mailing Address - Street 1:11941 MISTY COVE CT APT 101
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7145
Mailing Address - Country:US
Mailing Address - Phone:859-628-0514
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD RM 4A111
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered