Carly Mae Clearwater

Individual provider Active NPI Pediatric Occupational Therapist · West Milford, NJ

NPI 1902506751 · NPPES record last updated Feb 6, 2026

Key facts

NPI
1902506751
Entity type
Individual (NPI type 1)
Primary specialty
Pediatric Occupational Therapist 225XP0200X
License
46TR00887900 (NJ)
Practice address
1554 Union Valley Rd
West Milford, NJ 07480-1357
Phone
(860) 575-0428
NPI assigned
Mar 8, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 2

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
L-320763NJMDLactation Consultant (Non-RN)
46TR00887900NJMDPediatric Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Brave Wings Academy, LLP Past
since Mar 26, 2023
Accepting new patients
Brave Wings Therapy, PC Pediatrics Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Non-RN) 174N00000X L-320763 NJ
Pediatric Occupational Therapist 225XP0200X 46TR00887900 NJ Yes

Addresses

Primary practice location

1554 Union Valley Rd
West Milford, NJ 07480-1357

Mailing address

424 Canistear Rd
Stockholm, NJ 07460-1832
Phone (860) 575-0428

Other providers in West Milford, NJ

All providers in West Milford, NJ · Pediatric Occupational Therapist in New Jersey

Sources for this page

Verify at the official NPI Registry.