MEDICARE: DR. FLORENCE ARCURI CLARK PHD, OTR L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	4175	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4175	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1356554984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FLORENCE ARCURI CLARK PHD, OTR L

Provider Business Mailing Address
First Line	:	635 W 35TH ST
Second Line	:	# 2180
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	323-442-3340
Fax Number	:	323-442-3351

Provider Business Practice Location Address
First Line	:	2250 ALCAZAR ST
Second Line	:	CHP-133
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-9003
Country	:	US
Telephone Number	:	323-442-3340
Fax Number	:	323-442-3351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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