Alishia Monique Clark, OTR/L
Individual provider Active NPI Occupational Therapist · Hiddenite, NC
NPI 1376709394 · NPPES record last updated Jan 5, 2024
Key facts
- NPI
- 1376709394
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 5559 (NC)
- Practice address
- 792 Lackey Mountain Rd
Hiddenite, NC 28636-7251 - Phone
- (828) 635-8400
- NPI assigned
- Jul 29, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220208001301 | NC | Practitioner - Occupational Therapist in Private Practice | 3870983802 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5559 | NC | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paragon Outpatient Rehabilitation Services, LLC | Current |
Accepting new patients | |
| Paragon Outpatient Rehabilitation Services, LLC | Current |
Accepting new patients |
Locations
2605 Swallow Rd
Rm 201
Reidsville, NC 27320
Phone (704) 251-2602
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 5559 | NC | Yes |
Addresses
Primary practice location
792 Lackey Mountain Rd
Hiddenite, NC 28636-7251
Mailing address
792 Lackey Mountain Rd
Hiddenite, NC 28636-7251
Phone (704) 402-0686
Other providers in Hiddenite, NC
- Alexander Wellness Path PLLC
- Valerie Andersen
- Lydia Walker Bumgarner
- Shannon Steve Childers
- Counseling and Support Associates, PC
- Emma Danielle Hiott
- Cathleen C Johnstone
- Laura Quinn
- Ashley Kay Ridenour
All providers in Hiddenite, NC · Occupational Therapist in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.