Active NPI
Karen Danielle Clark, CTRS
- Recreation Therapist
- Phoenix, AZ
National Provider Identifier
1174826580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 225800000X
- Practice address
- 650 E Indian School Rd
Phoenix, AZ 85012-1839 - Phone
- (602) 277-5551
- NPI assigned
- Dec 8, 2010
- 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 |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 225800000X | Primary |
Addresses
Primary practice location
650 E Indian School Rd
Phoenix, AZ 85012-1839
Mailing address
5238 West Cinnabar Avenue
Glendale, AZ 85302
Phone (623) 518-2636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40919 | Other | NCTRC |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291766400000",
"number": "1174826580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5238 WEST CINNABAR AVENUE",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "85302",
"telephone_number": "623-518-2636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 E INDIAN SCHOOL RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850121839",
"telephone_number": "602-277-5551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KAREN",
"middle_name": "DANIELLE",
"name_prefix": "Mrs.",
"credential": "CTRS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-08",
"last_updated": "2010-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": null,
"license": "225800000X",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCTRC",
"identifier": "40919",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.