Active NPI
Rebecca Clark, COTA
- Massage Therapist
- Fort Smith, AR
National Provider Identifier
1619674843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 9293
- Practice address
- 2220 S Waldron Rd # 57
Fort Smith, AR 72903-3733 - Phone
- (479) 434-2371
- NPI assigned
- Feb 8, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OT2022-029 | AR | |
| Massage Therapist | 225700000X | 9293 | AR | Primary |
Addresses
Primary practice location
2220 S Waldron Rd # 57
Fort Smith, AR 72903-3733
Mailing address
2220 S Waldron Rd
Fort Smith, AR 72903-3733
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 |
|---|---|---|---|
| OT2022-029 | AR | MD | Occupational Therapy Assistant |
| 9293 | AR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709769600000",
"number": "1619674843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2220 S WALDRON RD",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729033733"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2220 S WALDRON RD # 57",
"city": "FORT SMITH",
"state": "AR",
"postal_code": "729033733",
"telephone_number": "479-434-2371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "REBECCA",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-08",
"last_updated": "2024-03-07",
"certification_date": "2024-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "AR",
"license": "OT2022-029",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AR",
"license": "9293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Smith, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.