Provider Demographics
NPI:1093603409
Name:MACK, CLARA GRACE (OTD)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:GRACE
Last Name:MACK
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 W NELSON ST APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2055
Mailing Address - Country:US
Mailing Address - Phone:612-850-0606
Mailing Address - Fax:
Practice Address - Street 1:1946 W NELSON ST APT 2W
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2055
Practice Address - Country:US
Practice Address - Phone:612-850-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist