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NPI Code Detail

MEDICARE: CARA LEANNE CLARK MOTR/L

MEDICARE: CARA LEANNE CLARK MOTR/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 Therapist5201008898MI

General Provider Information

NPI Number : 1932598992
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARA LEANNE CLARK MOTR/L
Provider Business Mailing Address
First Line : 15708 HUNTCLIFF DR
Second Line :
City : MACOMB
State : MI
Zip : 48044-3854
Country : US
Telephone Number : 586-293-1234
Fax Number :
Provider Business Practice Location Address
First Line : 30801 JEFFERSON AVE
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48082-1732
Country : US
Telephone Number : 586-293-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2015
Last Update Date : 02/01/2017

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Directions to “ CARA LEANNE CLARK MOTR/L” Practice Location

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