Provider Demographics
NPI:1205494275
Name:CLARK, VICTORIA (MS, OTR/L)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W PLUMB LANE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3683
Mailing Address - Country:US
Mailing Address - Phone:775-853-7513
Mailing Address - Fax:775-853-7523
Practice Address - Street 1:540 W PLUMB LANE
Practice Address - Street 2:SUITE 201
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3683
Practice Address - Country:US
Practice Address - Phone:775-853-7513
Practice Address - Fax:775-853-7523
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT19839225X00000X
225XP0019X
NV2199225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation