Leita Faye Clark, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OP000930L Issued in PA

Practice address

1008 Thompson St
Jersey Shore, PA 17740-1729

Phone

(570) 398-4747

NPI assigned

Oct 23, 2008

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

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224720000000",
    "number": "1235382177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "293 CHESTNUT RIDGE RD",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177408930",
            "telephone_number": "570-321-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 THOMPSON ST",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177401729",
            "telephone_number": "570-398-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "LEITA",
        "middle_name": "FAYE",
        "name_prefix": "Mrs.",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-23",
        "last_updated": "2008-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "PA",
            "license": "OP000930L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine A Brosius-Bolick, DO
• Amanda Lee Cagle, PHARMD
• Kirkland Campbell
• Nathan James Carpenter, DC
• Citizens Hose Company of Jersey Shore
• Thomas Carroll Connolly, M.D.
• Jonathan David Coote Jr., PA-C
• Crystal Renea Corl, COTA/L
• Reynaldo Navarro Cornel, M.D.
• Ashley Kay Craig, OTR/L

• Occupational Therapy Assistant in Jersey Shore, PA
• Providers in Jersey Shore, PA by specialty
• Occupational Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; 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.