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General NPI Number Information
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NPI Number | 1629771316
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Entity Type | Individual
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Provider Name | KARNA LEIAN CLARK COTA/L
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 213 E REDWOOD AVE
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City | SALLISAW
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State | OK
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Zip | 74955-2811
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Country | US
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Telephone | 918-774-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 14756 MCMILLIN LN
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City | POTEAU
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State | OK
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Zip | 74953-7393
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Country | US
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Telephone | 918-635-5833
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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 | OT-A1770
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License Number State | OK
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