Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 004730 | MO |
N | 224Z00000X | Occupational Therapy Assistant | 18-00598 | KS |
NPI | 1003008194 |
---|---|
Provider Name | Mrs. Cindy Clark |
First Address | Overland Park, KS 66214-3009 |
Second Address | Overland Park, KS 66214-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 13/08/2007 |