Provider Demographics
NPI:1316081920
Name:CLARKE, DENISE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 HIGHWAY 5 N
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3039
Mailing Address - Country:US
Mailing Address - Phone:870-425-2277
Mailing Address - Fax:870-425-2021
Practice Address - Street 1:360 HIGHWAY 5 N
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3039
Practice Address - Country:US
Practice Address - Phone:870-425-2277
Practice Address - Fax:870-425-2021
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR836225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AROTR836OtherLICENSE