Timilyn Clark, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT003260 Issued in GA

Practice address

1321 Sugarloaf Reserve Dr
Duluth, GA 30097

Phone

(770) 807-4503

Fax

(470) 517-7334

NPI assigned

Feb 28, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kaia Rehab & Wellness LLC

  • Occupational Therapist
  • Duluth, GA
  • NPI 1134873904
  NPD Authorized official

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

{
    "created_epoch": "1646006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1700532835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 STATE BRIDGE RD",
            "address_2": "STE G, #224",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "30097",
            "telephone_number": "770-807-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1321 SUGARLOAF RESERVE DR",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "30097",
            "telephone_number": "770-807-4503",
            "fax_number": "470-517-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TIMILYN",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-28",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT003260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Chung
• Seung Goo Chung, D.C
• Tracey Civil
• Colleen Clark
• Donte Clark
• Samantha Lee Claxton, OD
• Clayton R. Davis, D.M.D., P.C.
• Amber Clayton
• Dennis J Clayton, PAC
• Clement Ayanbadejo LLC

• Occupational Therapist in Duluth, GA
• Providers in Duluth, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; 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.