Koletta Rae Clarke, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

057.003262 Issued in IL

Practice address

208 Zachery Dr
Mount Vernon, IL 62864-6712

Phone

(618) 204-5497

NPI assigned

Apr 13, 2011

Last updated

Apr 13, 2011By 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

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

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302652800000",
    "number": "1285924092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13907 N DARTMOUTH LN",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649823",
            "telephone_number": "618-237-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 ZACHERY DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646712",
            "telephone_number": "618-204-5497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARKE",
        "first_name": "KOLETTA",
        "middle_name": "RAE",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-13",
        "last_updated": "2011-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "IL",
            "license": "057.003262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin B Claffey, M.D.
• Kimberly Rene Claffey, FNP-C
• Steven J Clark, MD
• Jamie Lynn Clarke, MSW
• Jill Clarke, PHARM. D.
• Clarkson Optometry Illinois PC (Clarkson Eye Care)
• Keith Alan Cloe, D.C.
• Paula Clouse, LCPC, LPC
• Ashlie Cole, RD, LDN
• Jamie Renee Cole, M.S., SLP-CCC

• Occupational Therapy Assistant in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Occupational Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; 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.