Melissa Newkam Clark, OTR/L
Individual provider Active NPI Pediatric Occupational Therapist · Braselton, GA
NPI 1063799682 · NPPES record last updated Nov 10, 2011
Key facts
- NPI
- 1063799682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- OT005376 (GA)
- Practice address
- 5745 Old Winder Hwy Ste C
Braselton, GA 30517-1637 - Phone
- (770) 965-1861
- NPI assigned
- Nov 10, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT005376 | GA | MD | Pediatric Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Occupational Therapist | 225XP0200X | OT005376 | GA | Yes |
Addresses
Primary practice location
5745 Old Winder Hwy Ste C
Braselton, GA 30517-1637
Mailing address
5745 Old Winder Hwy Ste C
Braselton, GA 30517-1637
Other providers in Braselton, GA
- Ken Kai Cheng
- Mary Lynn Epsten Chillemi
- Siva Chiranjeevi
- Lucy Warner Choi
- Seonah Choi
- Clarkson Optometry Georgia Inc
- Classic EMS Inc
- George K Cleland
- Joy Jones Cleveland
- Sylvia Alberta Collier
All providers in Braselton, GA · Pediatric Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.