Active NPI
Shannon Clark
- Occupational Therapy Assistant
- Westminster, CO
National Provider Identifier
1457786675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1072069
- Practice address
- 860 W 132ND Ave
SPC 268
Westminster, CO 80234-1499 - Phone
- (720) 495-2942
- NPI assigned
- Sep 6, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 Therapy Assistant | 224Z00000X | 1072069 | CO | Primary |
Addresses
Primary practice location
860 W 132ND Ave
SPC 268
Westminster, CO 80234-1499
Mailing address
860 W 132ND Ave
SPC 268
Westminster, CO 80234-1499
Phone (720) 495-2942
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1072069 | CO | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378425600000",
"number": "1457786675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 W 132ND AVE",
"address_2": "SPC 268",
"city": "WESTMINSTER",
"state": "CO",
"postal_code": "802341499",
"telephone_number": "720-495-2942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 W 132ND AVE",
"address_2": "SPC 268",
"city": "WESTMINSTER",
"state": "CO",
"postal_code": "802341499",
"telephone_number": "720-495-2942"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-09-06",
"last_updated": "2013-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CO",
"license": "1072069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westminster, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.