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General NPI Number Information
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NPI Number | 1629258140
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Entity Type | Organization
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Legal Business Name | CLARK ORTHOTIC SERVICES, INC.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 6315 E BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43213-1506
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Country | US
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Telephone | 614-863-6900
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Fax | 614-863-8787
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Provider Business Mailing Address
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Address Line | 6315 E BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43213-1506
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Country | US
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Telephone | 614-863-6900
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Fax | 614-863-8787
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN SIMMONS
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Credential | CO, LO
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Telephone | 614-863-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 192
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License Number State | OH
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