Provider Demographics
NPI:1699376798
Name:CLARK, EMILY ANNE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
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 1:18 INDIA PL
Mailing Address - Street 2:
Mailing Address - City:AMITY HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3579 BAYVIEW ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-3316
Practice Address - Country:US
Practice Address - Phone:516-639-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist