Provider Demographics
NPI:1033937255
Name:CLARK, ABBY LAYNE (COTA/L)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:LAYNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LAFAYETTE 21
Mailing Address - Street 2:
Mailing Address - City:BUCKNER
Mailing Address - State:AR
Mailing Address - Zip Code:71827-9510
Mailing Address - Country:US
Mailing Address - Phone:870-904-3086
Mailing Address - Fax:
Practice Address - Street 1:504 E 4TH ST N
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AR
Practice Address - Zip Code:71857-2254
Practice Address - Country:US
Practice Address - Phone:870-887-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTA-2062224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant