Mike A Clark, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Practice address

444 N Wells St Ste 304
Chicago, IL 60610-4593

Phone

(708) 757-5362

NPI assigned

May 31, 2007

Sex

Male

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639370984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23235 S VOLBRECHT RD",
            "city": "CRETE",
            "state": "IL",
            "postal_code": "604171789",
            "telephone_number": "708-757-5362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 N WELLS ST STE 304",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606104593",
            "telephone_number": "708-757-5362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MIKE",
        "middle_name": "A",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31001679A",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa P Clark, RD,LDN, CNSC
• Marcus Clark
• Margaret Harrigan Clark, M.A.
• Marlena Clark, PHD
• Melissa A Clark, LCSW
• Nancy S Clark, MD
• Clark, Nelson, and Associates, Inc.
• Richard N Clark Jr., MD
• Rona Clark
• Sara Elizabeth Clark, MS, OTR/L

• Occupational Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.