Active NPI
Jacqueline Clark
- Occupational Therapist
- Muskegon, MI
National Provider Identifier
1982175493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 5201001665
- Practice address
- 888 Terrace St
Muskegon, MI 49440-1220 - Phone
- (231) 672-4663
- NPI assigned
- Dec 10, 2018
- 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 | 5201001665 | MI | Primary |
Addresses
Primary practice location
888 Terrace St
Muskegon, MI 49440-1220
Mailing address
730 Ruddiman Dr
North Muskegon, MI 49445-2867
Phone (231) 744-6805
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 |
|---|---|---|---|
| 5201001665 | MI | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544400000000",
"number": "1982175493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 RUDDIMAN DR",
"city": "NORTH MUSKEGON",
"state": "MI",
"postal_code": "494452867",
"telephone_number": "231-744-6805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "888 TERRACE ST",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494401220",
"telephone_number": "231-672-4663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-10",
"last_updated": "2018-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "MI",
"license": "5201001665",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.