Jacqueline Clarke-Martin, MS, OTR/L
Individual provider Active NPI Contractor · Laurel, MD
NPI 1861949596 · NPPES record last updated Sep 11, 2016
Key facts
- NPI
- 1861949596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 03679 (MD)
- Practice address
- 13120 Brooktree LN
Laurel, MD 20707-9492 - Phone
- (240) 893-4157
- NPI assigned
- Sep 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03679 | MD | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 03679 | MD | Yes |
Addresses
Primary practice location
13120 Brooktree LN
Laurel, MD 20707-9492
Mailing address
13120 Brooktree LN
Laurel, MD 20707-9492
Phone (240) 893-4157
Other providers in Laurel, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2016. 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.