Active NPI
Katie Lynne Clark
- Occupational Therapist
- Las Vegas, NV
National Provider Identifier
1164760369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-2032
- Practice address
- 2012 S Jones Blvd
Las Vegas, NV 89146-3151 - Phone
- (702) 360-1137
- NPI assigned
- Jan 22, 2013
- 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 | OT-2032 | NV | Primary |
Addresses
Primary practice location
2012 S Jones Blvd
Las Vegas, NV 89146-3151
Mailing address
283 Deerleap Cir
Henderson, NV 89052-2340
Phone (702) 285-3153
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164760369 | Medicaid | NV |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1358812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544313600000",
"number": "1164760369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "283 DEERLEAP CIR",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890522340",
"telephone_number": "702-285-3153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2012 S JONES BLVD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891463151",
"telephone_number": "702-360-1137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KATIE",
"middle_name": "LYNNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-22",
"last_updated": "2018-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NV",
"license": "OT-2032",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1164760369",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.