Jackie Clark
Individual provider Active NPI Occupational Therapist · Parrish, FL
NPI 1124474457 · NPPES record last updated Dec 6, 2016
Key facts
- NPI
- 1124474457
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT14395 (FL)
- Practice address
- 11472 Walden Loop
Parrish, FL 34219-7565 - Phone
- (941) 806-7555
- NPI assigned
- May 5, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2145 Midnight Pearl Dr
Sarasota, FL 34240-2416
Phone (941) 725-1527
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231213001000 | FL | Practitioner - Occupational Therapist in Private Practice | 3375978018 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT14395 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Home Therapy LLC | Occupational Therapist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT14395 | FL | Yes |
Addresses
Primary practice location
11472 Walden Loop
Parrish, FL 34219-7565
Mailing address
11472 Walden Loop
Parrish, FL 34219-7565
Phone (941) 806-7555
Other providers in Parrish, FL
- Tiara L Bryant
- Donna Cabibi
- Caring for Angels Caregiving LLC
- Rebecca Casey
- Rey Causin
- Col 323 Professional Services, LLC
- Jessica L Colbert
- William W Colgate
- Kilstron Collins
- Comfortable Care Dental Health Professionals, P.a.
All providers in Parrish, FL · Occupational Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2016. 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.