Active NPI
Camiel Clark, OTR/L
- Occupational Therapist
- Pocatello, ID
National Provider Identifier
1821534439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT-1635
- Practice address
- 1071 Renee Ave
Pocatello, ID 83201-2508 - Phone
- (208) 233-1411
- NPI assigned
- Jan 6, 2017
- 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 | OT-1635 | ID | Primary |
Addresses
Primary practice location
1071 Renee Ave
Pocatello, ID 83201-2508
Mailing address
1615 E Clark St
Pocatello, ID 83201-4049
Phone (907) 252-7295
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OT-1635 | Other | ID | AOTA |
Other names 1
- Camiel Lynn Eberline
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 |
|---|---|---|---|
| OT-1635 | ID | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1483660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1483660800000",
"number": "1821534439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 E CLARK ST",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014049",
"telephone_number": "907-252-7295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1071 RENEE AVE",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832012508",
"telephone_number": "208-233-1411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "CAMIEL",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-01-06",
"last_updated": "2017-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ID",
"license": "OT-1635",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AOTA",
"identifier": "OT-1635",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CAMIEL",
"last_name": "EBERLINE",
"middle_name": "LYNN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.