Active NPI
Kelsey Nichole Clark, OTR/L
- Occupational Therapist
- Kingwood, WV
National Provider Identifier
1144510629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1406
- Practice address
- 150 Memorial Dr
Kingwood, WV 26537-1141 - Phone
- (304) 329-1400
- NPI assigned
- Apr 18, 2011
- Last updated
- Aug 15, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1406 | WV | Primary |
Addresses
Primary practice location
150 Memorial Dr
Kingwood, WV 26537-1141
Mailing address
150 Memorial Dr
Kingwood, WV 26537-1141
Phone (304) 329-1400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1406 | WV | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723680000000",
"number": "1144510629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 MEMORIAL DR",
"city": "KINGWOOD",
"state": "WV",
"postal_code": "265371141",
"telephone_number": "304-329-1400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 MEMORIAL DR",
"city": "KINGWOOD",
"state": "WV",
"postal_code": "265371141",
"telephone_number": "304-329-1400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KELSEY",
"middle_name": "NICHOLE",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-18",
"last_updated": "2024-08-15",
"certification_date": "2024-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WV",
"license": "1406",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingwood, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.