MR. KEVIN JOHN CLARK (NPI# 1790115004) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790115004 |
| Entity Type | Individual |
| Full Name | MR. KEVIN JOHN CLARK |
| Credential | LCPO |
| Practice Address |
411 12th Ave Suite 200 Seattle WA 98122-5599 |
| Practice Telephone | 2063284276 |
| Practice Fax Number | 2063281037 |
| Mailing Telephone | 2063284276 |
| Mailing Fax Number | 2063281037 |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2013-11-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | 01 60414623 | WA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 224P00000X | Prosthetist | PS 60414610 | WA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | 9015561 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598294001 | Kevin John Clark | Chiropractor | 2815 83rd St, Darien, IL 60561-1660 | 2017-06-08 |
| 1124402516 | Kevin Michael Clark | Dentist | 8 Inwood Peak, San Antonio, TX 78248-1654 | 2015-07-15 |
| 1275976276 | Kevin P Clark | Pharmacist | 215 Sixth Street, Hotchkiss, CO 81419-0928 | 2013-04-10 |
| 1265736508 | Kevin Clark | Acupuncturist | 415 Route 34, Suite 210, Colts Neck, NJ 07722-2522 | 2010-12-30 |
| 1033361381 | Kevin Dewitt Clark | Acupuncturist | 130 N Dixie Hwy, Hollywood, FL 33020-6704 | 2008-10-17 |
| 1891859278 | Kevin Landis Clark | Optometrist | 10415 Gateway Blvd W, El Paso, TX 79925-7905 | 2006-12-20 |
| 1609934397 | Kevin John Clark | Counselor | 251 E 5th St, Brooklyn, NY 11218-2403 | 2006-12-05 |
| 1912947144 | Kevin Grafton Clark | Optometrist | 5310 Highway 25, Suite 5, Flowood, MS 39232-6148 | 2006-06-07 |
| 1235127291 | Kevin N Clark | Surgery | 425 Medical Dr, Ste 101, Bountiful, UT 84010-4945 | 2005-10-12 |
| 1497376958 | Kevin P. Clark Sr. | Social Worker | 30 Harriman Dr, Goshen, NY 10924-2410 | 2020-05-06 |
| Street Address |
411 12TH AVE SUITE 200 |
| City | SEATTLE |
| State | WA |
| Zip Code | 98122-5599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396749990 | Center for Prosthetics Orthotics, Inc. | Specialist | 411 12th Ave, Seattle, WA 98122-5577 | 2005-06-10 |
| 1376084608 | Christina Minh | Prosthetist | 411 12th Ave, Suite 200, Seattle, WA 98122-5577 | 2017-03-20 |
| 1255787701 | Alan R. Breen, Phd, Pllc | Clinical Neuropsychologist | 411 12th Ave, Ste 305, Seattle, WA 98122 | 2016-05-13 |
| 1912336025 | Center for Prosthetics Orthotics, Inc. | Prosthetic/Orthotic Supplier | 411 12th Ave, Suite 200, Seattle, WA 98122-5599 | 2013-11-08 |
| 1144654237 | Sharon J Lee | Orthotist | 411 12th Ave, Suite 200, Seattle, WA 98122-5599 | 2013-08-26 |
| 1003108804 | Gregory T Ferguson | Specialist | 411 12th Ave, Suite 200, Seattle, WA 98122-5599 | 2011-05-11 |
| 1255667143 | Julie Lund Schaar | Specialist | 411 12th Ave, Suite 200, Seattle, WA 98122-5599 | 2009-10-27 |
| 1821271909 | Rhea Kulikova | Specialist | 411 12th Ave, Seattle, WA 98122-5577 | 2007-12-11 |
| 1790975241 | David Tweedy | Specialist | 411 12th Ave, Seattle, WA 98122-5577 | 2007-07-31 |
| 1508056599 | David Varnau | Specialist | 411 12th Ave, Seattle, WA 98122-5577 | 2007-07-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053938506 | Quality Counseling and Consultation Service LLC | Counselor | 1525 Harvard Ave #509, Seattle, WA 98122 | 2020-07-01 |
| 1912535626 | Cesar Andrade | Student in an Organized Health Care Education/Training Program | 550 16th Avenue #400, Seattle, WA 98122 | 2020-03-29 |
| 1366089666 | Peter Nguyen | Pharmacy Technician | 914 East Jefferson Street, Campion Hall, Seattle, WA 98122 | 2019-12-05 |
| 1356903140 | Jason Dandino | Specialist/Technologist | 550 14th Avenue, Seattle, WA 98122 | 2019-07-02 |
| 1962066415 | Seattle Colleges | Local Education Agency (LEA) | Mainstay At Seattle Central College, 1701 Broadway Ms Be3210, Seattle, WA 98122 | 2019-04-30 |
| 1538621412 | Mitchell R Ornelas | Student in an Organized Health Care Education/Training Program | Swedish Family Medicine Residency Cherry Hill; 550 16th, Avenue #400, Seattle, WA 98122 | 2019-04-01 |
| 1003374265 | Michael Russell | Surgery | 747 Broadway Heath Building 10th Floor, Seattle, WA 98122 | 2019-03-06 |
| 1639646821 | Maritza E Cajiao | Doula | 747 Broadway, Seattle, Seattle, WA 98122 | 2018-10-25 |
| 1336616762 | Suzanna M Lovin | Social Worker | 401 Broadway, 1st Floor, Seattle, WA 98122 | 2018-10-24 |
| 1184137770 | Walter Franklin Krengel Jr. | Orthopaedic Surgery | 2000 1st Ave Suite 2201, Seattle, WA 98122 | 2017-11-06 |
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| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275077851 | Geoffrey Balkman | Orthotist | 501 Eastlake Ave E Ste 300, Seattle, WA 98109-5546 | 2016-12-15 |
| 1427461060 | Donn Oshiro | Orthotist | 650 S Orcas St Ste 100, Seattle, WA 98108-2654 | 2014-06-10 |
| 1003240797 | Patrick Henry Stempski | Orthotist | 501 Eastlake Avenue East, Suite 300, Seattle, WA 98109 | 2013-08-29 |
| 1881882637 | William Maschmeier | Orthotist | 600 Broadway Ste 190, Seattle, WA 98122-5371 | 2007-10-05 |
| 1659439032 | Daniel C. Abrahamson | Orthotist | 501 Eastlake Ave E, Suite 300, Seattle, WA 98109-5546 | 2006-12-05 |
| 1932267531 | Stephanie W. Yoshino | Orthotist | 501 Eastlake Ave East, Suite 300, Seattle, WA 98109-5503 | 2006-12-05 |
| 1275539264 | J Kirk Douglass | Orthotist | 10740 Meridian Ave N, Ste G2, Seattle, WA 98133-9010 | 2005-06-23 |
| 1790318376 | Bryan Gregory Gerhard | Orthotist | 10740 Meridian Ave N Ste G2, Seattle, WA 98133-9010 | 2020-02-21 |
| 1962987099 | Zachary Worthington | Orthotist | 1101 Madison St Ste 550, Seattle, WA 98104-1320 | 2018-09-25 |
| 1083110431 | George Eli Kaufman | Orthotist | 1660 S Columbian Way, Seattle, WA 98108-1532 | 2018-04-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.