Bailey Clark, COTA/L
Individual provider Active NPI Occupational Therapy Assistant · Lake Butler, FL
NPI 1750964706 · NPPES record last updated Apr 28, 2021
Key facts
- NPI
- 1750964706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- OTA17741 (FL)
- Practice address
- 850 E Main St
Lake Butler, FL 32054-1353 - Phone
- (386) 496-2323
- NPI assigned
- Apr 28, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA17741 | FL | MD | Occupational Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA17741 | FL | Yes |
Addresses
Primary practice location
850 E Main St
Lake Butler, FL 32054-1353
Mailing address
692 NE State Road 16
Starke, FL 32091
Other providers in Lake Butler, FL
- Laura Caswell
- Allison Nicole Catarelli
- Cccnf - Lake Butler, LLC
- Kelly Melinda Chewning
- Susan Child
- Kelly Darlene Clark
- Lisa Cunningham
- Patrick Cunningham
- Carolyn L Deloache
- District School Board of Union County
All providers in Lake Butler, FL · Occupational Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.