Tanya Lee Clark, OTD, OTR/L
Individual provider Active NPI Occupational Therapist · North Grosvenordale, CT
NPI 1427485192 · NPPES record last updated Mar 10, 2024
Key facts
- NPI
- 1427485192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 4145 (CT)
- Practice address
- 113 Labby Rd
North Grosvenordale, CT 06255-1247 - Phone
- (860) 497-0239
- Fax
- (860) 497-0047
- NPI assigned
- Sep 26, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Outpatient Mobile Solutions, Inc.
Practice addresses (Care Compare)
113 Labby Rd
North Grosvenordale, CT 06255-1247
Phone (860) 497-0239
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT, MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190613001397 | CT | Practitioner - Occupational Therapist in Private Practice | 0941533871 | Reassigns benefits to 1 organization |
| I20200113001568 | MA | Practitioner - Occupational Therapist in Private Practice | 0941533871 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10108 | MA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Outpatient Mobile Solutions, Inc. | Occupational Therapist | Current |
Accepting new patients |
| Outpatient Mobile | Occupational Therapist | Current |
Accepting new patients |
Locations
365 Main St
Ste 101
Worcester, MA 01608
Phone (860) 497-0239
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 10108 | MA | |
| Occupational Therapist | 225X00000X | 4145 | CT | Yes |
Addresses
Primary practice location
113 Labby Rd
North Grosvenordale, CT 06255-1247
Mailing address
113 Labby Rd
North Grosvenordale, CT 06255-1247
Phone (607) 643-2178
Other providers in North Grosvenordale, CT
- Noah Demers Aubin
- Behavior Services of New England
- Kailey Bennett
- Nita Chatterjee
- Natalee Giselle Cifuentes
- Lisa Kim Diamond
- Kristine Marie Dipasquale
- Beth Ann Flannery Spillane
- Melissa Ann Gobin-Borski
- Christina M Labby
All providers in North Grosvenordale, CT · Occupational Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.