Erin Yvette Clark, OTR/L
Individual provider Active NPI Occupational Therapist · Mitchellville, MD
NPI 1093389439 · NPPES record last updated Jan 11, 2024
Key facts
- NPI
- 1093389439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 09989 (MD)
- Practice address
- 12158 Central Ave
Mitchellville, MD 20721-1932 - Phone
- (301) 430-2706
- NPI assigned
- May 19, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Howard University College of Medicine, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
14435 Aden Rd
Nokesville, VA 20181-3122
614 Oneida St NE
Washington, DC 20011-1640
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251201000562 | DC | Practitioner - Occupational Therapist in Private Practice | 3476046319 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neurosuite LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 09989 | MD | Yes |
Addresses
Primary practice location
12158 Central Ave
Mitchellville, MD 20721-1932
Mailing address
12158 Central Ave
Mitchellville, MD 20721-1932
Phone (301) 390-3076
NPI Registry JSON
{
"created_epoch": "1621382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1093389439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12158 CENTRAL AVE",
"city": "MITCHELLVILLE",
"state": "MD",
"postal_code": "207211932",
"telephone_number": "301-390-3076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12158 CENTRAL AVE",
"city": "MITCHELLVILLE",
"state": "MD",
"postal_code": "207211932",
"telephone_number": "301-430-2706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ERIN",
"middle_name": "YVETTE",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-19",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MD",
"license": "09989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mitchellville, MD
- Cardiology Associates, LLC
- David A Carrington
- Jasmin Estefani Casco Nataren
- Cignet Health
- Cignet Specialist Care
- Lauren Jean Clark
- Kamar Clarke
- Collington Episcopal Life Care Community Inc
- Comprehensive Allergy and Asthma Care Center, LLC
- Comprehensive Rehab Consultants PLLC
All providers in Mitchellville, MD · Occupational Therapist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.