Tiarra Danielle Waller, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2021006924 Issued in MO

Practice address

21964 Highway 32
Ste Genevieve, MO 63670-9190

Phone

(573) 883-9366

Fax

(573) 883-9377

NPI assigned

May 16, 2022

Last updated

May 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Tiarra Danielle Sparkman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mid America Rehab, P.C.

  • Physical Therapist
  • Cape Girardeau, MO
  • NPI 1639143357

  Occupational Therapist

  NPD
• Ste Genevieve County Memorial Hospital

  dba Bloomsdale Family Health Care

  • Rural Health Clinic/Center
  • Bloomsdale, MO
  • NPI 1184658387
  NPD
• Ste Genevieve County Memorial Hospital

  dba Bloomsdale Imaging Center

  • Radiology Clinic/Center
  • Bloomsdale, MO
  • NPI 1902153539
  NPD
• Ste. Genevieve County Memorial Hospital

  dba Bloomsdale Specialty Clinic

  • Foot Surgery Podiatrist
  • Bloomsdale, MO
  • NPI 1104692946
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1295472884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21964 HIGHWAY 32",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636709190",
            "telephone_number": "573-883-9366",
            "fax_number": "573-883-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21964 HIGHWAY 32",
            "city": "STE GENEVIEVE",
            "state": "MO",
            "postal_code": "636709190",
            "telephone_number": "573-883-9366",
            "fax_number": "573-883-9377"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "490 Highway 61",
            "address_purpose": "LOCATION",
            "city": "Bloomsdale",
            "state": "MO",
            "postal_code": "636279131",
            "country_code": "US",
            "telephone_number": "573-483-5040",
            "fax_number": "573-483-5041",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "TIARRA",
        "middle_name": "DANIELLE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2021006924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIARRA",
            "last_name": "SPARKMAN",
            "middle_name": "DANIELLE",
            "credential": "OTR/L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Occupational Therapist in Ste Genevieve, MO
• Providers in Ste Genevieve, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.