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NPI Code Detail

MEDICARE: LILA R CLARK OTD, OTR/L

MEDICARE: LILA R CLARK OTD, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist

General Provider Information

NPI Number : 1558293555
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILA R CLARK OTD, OTR/L
Provider Business Mailing Address
First Line : 9002 MAPLE GROVE DR
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29485-8865
Country : US
Telephone Number : 843-697-4184
Fax Number :
Provider Business Practice Location Address
First Line : 2230 ASHLEY CROSSING DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-5700
Country : US
Telephone Number : 843-766-5228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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