Nicole Clark, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA01080 Issued in RI

Practice address

1526 Atwood Ave Ste 202
Johnston, RI 02919-3289

Phone

(401) 642-8080

NPI assigned

Feb 5, 2025

Last updated

Feb 5, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Pediatric Evolution, LLC.

  • Pediatrics Physician
  • Johnston, RI
  • NPI 1770244774
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1184438475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SCOTT DR",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1526 ATWOOD AVE STE 202",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029193289",
            "telephone_number": "401-642-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-05",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "RI",
            "license": "OTA01080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Marcus Christian, MD
• Victoria Grace Christie
• Michael C Chu, PHARM.D.
• Dino Ciarniello, PT
• Robert Michael Cicione, LICSW
• Coastal Medical, Inc.
• Chancelor Coffey, PHYSICAL THERAPIST
• Steven Marc Colagiovanni, M.D.
• Alexandrea Elena Colangelo, FNP-C
• Marcella Marie Colardo

• Occupational Therapy Assistant in Johnston, RI
• Providers in Johnston, RI by specialty
• Occupational Therapy Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.