Jameshia Clark

Individual provider Active NPI Occupational Therapy Assistant · Deland, FL

NPI 1154887743 · NPPES record last updated Feb 19, 2019

Key facts

NPI
1154887743
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
OTA11953 (FL)
Practice address
400 E Howry Ave
Deland, FL 32724-5400
Phone
(386) 822-6900
NPI assigned
Feb 19, 2019
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

LicenseStateTypeSpecialty
OTA11953FLMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X OTA11953 FL Yes

Addresses

Primary practice location

400 E Howry Ave
Deland, FL 32724-5400

Mailing address

8477 S Suncoast Blvd
Homosassa, FL 34446-5028
Phone (352) 382-1141

Other providers in Deland, FL

All providers in Deland, FL · Occupational Therapy Assistant in Florida

Sources for this page

Verify at the official NPI Registry.