Healthcare Provider Details

I. General information

NPI: 1720003726
Provider Name (Legal Business Name): MARGARET C CLARKE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 WATERMAN AVE
EAST PROVIDENCE RI
02914-1712
US

IV. Provider business mailing address

667 WATERMAN AVE
EAST PROVIDENCE RI
02914-1712
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-9500
  • Fax:
Mailing address:
  • Phone: 401-438-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT00410
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: