Active NPI
Valensia Clark
- Occupational Therapy Assistant
- Conway, SC
National Provider Identifier
1174990923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 3462
- Practice address
- 2828 Green Pond Cir
Conway, SC 29527-5143 - Phone
- (803) 439-8203
- NPI assigned
- Aug 27, 2015
- Last updated
- Aug 6, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 3462 | SC | Primary |
| Environmental Modification Occupational Therapy Assistant | 224ZE0001X | 3462 | SC |
Addresses
Primary practice location
2828 Green Pond Cir
Conway, SC 29527-5143
Mailing address
2828 Green Pond Cir
Conway, SC 29527-5143
Phone (803) 439-8203
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3462 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1174990923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2828 GREEN POND CIR",
"city": "CONWAY",
"state": "SC",
"postal_code": "295275143",
"telephone_number": "803-439-8203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2828 GREEN POND CIR",
"city": "CONWAY",
"state": "SC",
"postal_code": "295275143",
"telephone_number": "803-439-8203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "VALENSIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-27",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "SC",
"license": "3462",
"primary": true
},
{
"code": "224ZE0001X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant, Environmental Modification",
"state": "SC",
"license": "3462",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
- William M Cicio, M.D.
- Cindy Care Health Care LLC
- Heather June Cini, PMNHP
- Fran Caroline Clark, M.ED
- Nichole Louise Clark, FNP
- Linda Sharlene Clinebell, FNP-C
- Clinic Services of South Carolina PC
- Clinical Pathology Consultants, PA
- Coastal Cancer Center LLC (Coastal Cancer Center)
- Coastal Carolina Centers of Urology and Surgery LLC (Rivertown Surgery Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.