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General NPI Number Information
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NPI Number | 1790579340
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Entity Type | Individual
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Provider Name | LAURA-LIN CLARK OTD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 205 SOUTH ST E
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City | TALLADEGA
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State | AL
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Zip | 35160-2411
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Country | US
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Telephone | 256-761-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 203 E DAMON AVE
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City | TALLADEGA
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State | AL
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Zip | 35160-3213
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Country | US
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Telephone | 256-698-0013
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 6594
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 6594
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License Number State | AL
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