Teresa M Clark, OTR
Individual provider Active NPI Occupational Therapist · Mora, MN
NPI 1912307109 · NPPES record last updated Aug 26, 2014
Key facts
- NPI
- 1912307109
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 103264 (MN)
- Practice address
- 301 Highway 65 S
Mora, MN 55051-1899 - Phone
- (320) 225-3356
- Fax
- (320) 225-3370
- NPI assigned
- Aug 26, 2014
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3919-26 | WI | MD | Occupational Therapist |
Interoperability endpoints
- tclark210366@excellian.direct.allina.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 103264 | MN | Yes |
| Occupational Therapist | 225X00000X | 3919-26 | WI |
Addresses
Primary practice location
301 Highway 65 S
Mora, MN 55051-1899
Mailing address
19302 Friesland Rd
Hinckley, MN 55037-4768
Phone (320) 225-3356
Other providers in Mora, MN
- Sadie Briana Broekemeier
- Joseph John Buckley
- Aimee Burk
- Tanya Lynn Carlson
- Roberta Lorraine Casaday
- Coborns Inc
- Coborns Inc
- Benjamin Bryan Coleman
- Renee L Coleman
- Pamela Cone
All providers in Mora, MN · Occupational Therapist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 26, 2014. 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.