Provider Demographics
NPI:1205045374
Name:CLARK, ROBIN KAYE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:KAYE
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:AHLENIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:512 U ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1232
Mailing Address - Country:US
Mailing Address - Phone:719-252-3446
Mailing Address - Fax:
Practice Address - Street 1:3601 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5309
Practice Address - Country:US
Practice Address - Phone:916-365-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48538361Medicaid