Briana Clark
Individual provider Active NPI Occupational Therapist · Chesterton, IN
NPI 1972045748 · NPPES record last updated May 23, 2022
Key facts
- NPI
- 1972045748
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 31006965A (IN)
- Practice address
- 1595 S Calumet Rd Ste 3
Chesterton, IN 46304-2389 - Phone
- (219) 764-4888
- NPI assigned
- Nov 10, 2016
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
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 |
|---|---|---|---|
| 31006965A | IN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacob'S Ladder Pediatric Rehab Center | Current |
Accepting new patients | |
| Jacob'S Ladder Pediatric Rehab Center | Occupational Therapist | Current |
Accepting new patients |
Locations
1595 S Calumet Rd
Ste 3
Chesterton, IN 46304
Phone (219) 250-3202
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 31006965A | IN | Yes |
Addresses
Primary practice location
1595 S Calumet Rd Ste 3
Chesterton, IN 46304-2389
Mailing address
1595 S Calumet Rd Ste 3
Chesterton, IN 46304-2389
Phone (219) 764-4888
Other practice location 1
8001 SW 36th St
Suite 9
Davie, FL 33328-1915
Phone (954) 577-7790
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200196020A | Medicaid | IN |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | briana.clark@jacobskids.org |
Other providers in Chesterton, IN
- Chesterton Smiles Inc
- Chesterton Surgery Center LLC
- Jamie Chin-Theodorou
- Laura Lynn Cipowski
- Lindsey M Cirak
- Ashley Cline
- Rachael Cloud
- Isabelle Coccia
- Marcy Cohn
- Trisha Collazo
All providers in Chesterton, IN · Occupational Therapist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2022. 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.