Active NPI
Alicia Clark, MDT
- Occupational Therapist
- Lubbock, TX
National Provider Identifier
1295926665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 112359
- Practice address
- 25 Briercroft Office Park
Lubbock, TX 79412-3011 - Phone
- (806) 795-7433
- Fax
- (806) 795-7407
- NPI assigned
- Aug 9, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 112359 | TX | Primary |
Addresses
Primary practice location
25 Briercroft Office Park
Lubbock, TX 79412-3011
Mailing address
4601 66TH Street
Ste D
Lubbock, TX 79414
Phone (866) 832-1708
Other names 1
- Alicia Vanwinkle
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112359 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621987200000",
"number": "1295926665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4601 66TH STREET",
"address_2": "STE D",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "79414",
"telephone_number": "866-832-1708",
"fax_number": "888-789-4391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 BRIERCROFT OFFICE PARK",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794123011",
"telephone_number": "806-795-7433",
"fax_number": "806-795-7407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ALICIA",
"credential": "MDT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-08-09",
"last_updated": "2021-05-26",
"certification_date": "2021-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "112359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ALICIA",
"last_name": "VANWINKLE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.