Michelle Clark, OTR/L

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

721 Issued in CA

Practice address

6276 Jackie Ave
Woodland Hills, CA 91367-1422

Phone

(818) 439-7535

Fax

(818) 884-8674

NPI assigned

Feb 19, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1329609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329609600000",
    "number": "1457624686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6276 JACKIE AVE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913671422",
            "telephone_number": "818-439-7535",
            "fax_number": "818-884-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6276 JACKIE AVE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913671422",
            "telephone_number": "818-439-7535",
            "fax_number": "818-884-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-02-19",
        "last_updated": "2012-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "CA",
            "license": "721",
            "primary": true
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "CA",
            "license": "721",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florina Kathy Cisneros
• Joanna Marie Cisneros
• City Diagnostic Medical Group, Inc.
• Clarient Diagnostic Services, Inc.
• Mary Alden Clark
• Nikketa R Clark
• Shawn Clark
• Suzanne H Clark, NP
• Julie Clarke, MD
• Riley Clarke

• Physical Rehabilitation Occupational Therapist in Woodland Hills, CA
• Providers in Woodland Hills, CA by specialty
• Physical Rehabilitation Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2012; 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.