Provider Demographics
NPI:1306114079
Name:CLARK, ANNE NAOMI (OTR)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:NAOMI
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4016
Mailing Address - Street 2:
Mailing Address - City:TELLURIDE
Mailing Address - State:CO
Mailing Address - Zip Code:81435-4016
Mailing Address - Country:US
Mailing Address - Phone:970-404-0130
Mailing Address - Fax:
Practice Address - Street 1:327 NORTH FIR STREET
Practice Address - Street 2:APT C
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435-4016
Practice Address - Country:US
Practice Address - Phone:970-404-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT-2635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist