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General NPI Number Information
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NPI Number | 1982182309
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Entity Type | Individual
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Provider Name | ANDREA K CLARK
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Gender | Female
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 920 GOLDENROD LN
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City | HICKMAN
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State | NE
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Zip | 68372-9509
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Country | US
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Telephone | 402-560-3651
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Fax |
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Provider Business Mailing Address
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Address Line | 20318 180TH ST
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City | ROCKWELL
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State | IA
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Zip | 50469-8680
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Country | US
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Telephone | 402-560-3651
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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 | 2227
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License Number State | NE
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