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NPI Code Detail

MEDICARE: DAVID CHARLES CLARKE OTR/L

MEDICARE: DAVID CHARLES CLARKE 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
1225X00000XOccupational Therapist63-004221NY

General Provider Information

NPI Number : 1558637181
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID CHARLES CLARKE OTR/L
Provider Business Mailing Address
First Line : 15 FAIRFIELD ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-1823
Country : US
Telephone Number : 718-356-8575
Fax Number :
Provider Business Practice Location Address
First Line : 15 FAIRFIELD ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10308-1823
Country : US
Telephone Number : 718-356-8575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2012
Last Update Date : 03/28/2012

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