Charley Clark, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

216616 Issued in TX

Practice address

9514 Console Dr
San Antonio, TX 78229-2069

Phone

(210) 448-9111

NPI assigned

Mar 16, 2021

Sex

Female

Sole proprietor

Yes

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

• A Plus Family Care LLC

  • Home Health Agency
  • San Antonio, TX
  • NPI 1861439754
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 16, 2021.

{
    "created_epoch": "1615852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1235714775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9514 CONSOLE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9514 CONSOLE DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782292069",
            "telephone_number": "210-448-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLEY",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "TX",
            "license": "216616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "clarkcharley88@gmail.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "9514 Console Dr",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782292069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Austin Clark
• Brian D. Clark, PA-C
• Catherine Mary Clark, M.A.T., BCBA
• Cecelia Marie Clark
• Charles Lee Clark, DDS
• Clayton Lohiau Clark, DC
• Cooper M Clark, D.O.
• Cynthia Clark, LCDC
• Danielle Clark, PT
• Daymond Clark

• All providers in San Antonio, TX
• Occupational Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; 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.