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General NPI Number Information
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NPI Number | 1912083098
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Entity Type | Individual
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Provider Name | LORI LOUANNE CLARK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 10515 W MARKHAM ST STE H10
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City | LITTLE ROCK
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State | AR
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Zip | 72205-2284
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Country | US
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Telephone | 501-823-0578
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Fax |
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Provider Business Mailing Address
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Address Line | 5810 KAREN DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72118-1233
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Country | US
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Telephone | 501-851-7981
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Fax | 501-851-7981
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OTR1368
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License Number State | AR
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