Carmen Michelle Clark
Individual provider Active NPI Developmental Therapist · Crestwood, KY
NPI 1124463450 · NPPES record last updated Apr 30, 2013
Key facts
- NPI
- 1124463450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmental Therapist 222Q00000X
- Practice address
- 7302 Meadow Rd
Crestwood, KY 40014-9453 - Phone
- (502) 241-5159
- NPI assigned
- Apr 30, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | KY | Yes |
Addresses
Primary practice location
7302 Meadow Rd
Crestwood, KY 40014-9453
Mailing address
7302 Meadow Rd
Crestwood, KY 40014-9453
Phone (502) 241-5159
Other providers in Crestwood, KY
- Bridgette Loreen Carroll
- Laura R Carroll
- Keegan Chandler
- Charis Healthcare PLLC
- Niles Charlet
- Thomas Jaggers Clark
- Stephanie Kay Clegg
- Hailey Coffey
- Tiffany Cole Hall
- Commonwealth of Kentucky
All providers in Crestwood, KY · Developmental Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2013. 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.