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General NPI Number Information
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NPI Number | 1518563469
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Entity Type | Individual
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Provider Name | CATHLEEN H CLARK
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Gender | Female
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 447 SILVER MINE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-4230
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Country | US
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Telephone | 719-322-8218
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Fax |
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Provider Business Mailing Address
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Address Line | 447 SILVER MINE DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-4230
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Country | US
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Telephone | 719-322-8218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0000248
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 000248
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License Number State | CO
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