MEDICARE: ANIKA CLARKE-KINGSTON

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	06670	MD

General Provider Information

NPI Number	:	1730450438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIKA CLARKE-KINGSTON

Provider Business Mailing Address
First Line	:	8612 INDIAN SPRINGS RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-1910
Country	:	US
Telephone Number	:	301-455-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 GATESHEAD MANOR WAY
Second Line	:	202
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-6112
Country	:	US
Telephone Number	:	301-455-0912
Fax Number	:

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

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	05/19/2021

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Directions to “ ANIKA CLARKE-KINGSTON ” Practice Location

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