Active NPI
Kristen Clark, MS OTR/L
- Occupational Therapist
- Grand Rapids, MI
National Provider Identifier
1750884508
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 100 Michigan St NE
Grand Rapids, MI 49503-2560 - Phone
- (616) 391-2719
- NPI assigned
- Mar 16, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary |
Addresses
Primary practice location
100 Michigan St NE
Grand Rapids, MI 49503-2560
Mailing address
5874 Bayberry Farms Dr SW Apt 9
Wyoming, MI 49418-9398
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521158400000",
"number": "1750884508",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5874 BAYBERRY FARMS DR SW APT 9",
"city": "WYOMING",
"state": "MI",
"postal_code": "494189398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560",
"telephone_number": "616-391-2719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KRISTEN",
"credential": "MS OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-16",
"last_updated": "2018-03-16",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.