Healthcare Provider Details

I. General information

NPI: 1457281750
Provider Name (Legal Business Name): ANGELA CLARKE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 N DREAMY DRAW DR STE 120
PHOENIX AZ
85020-4641
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 120
PHOENIX AZ
85020-4641
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-7470
  • Fax:
Mailing address:
  • Phone: 602-870-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-006867
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: