Provider Demographics
NPI:1740078955
Name:CLARK, EMMA (OTD, LOTR)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:CLARK
Suffix:
Gender:
Credentials:OTD, LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27130 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-3108
Mailing Address - Country:US
Mailing Address - Phone:225-209-8248
Mailing Address - Fax:
Practice Address - Street 1:37278 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3487
Practice Address - Country:US
Practice Address - Phone:225-744-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA346048225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics