Provider Demographics
NPI:1326431578
Name:CLARK, BROOKE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 W 32ND ST
Mailing Address - Street 2:#604
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38 W 32ND ST
Practice Address - Street 2:#604
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3816
Practice Address - Country:US
Practice Address - Phone:212-290-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019215-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics