Provider Demographics
NPI:1730450438
Name:CLARKE-KINGSTON, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:CLARKE-KINGSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-1910
Mailing Address - Country:US
Mailing Address - Phone:301-455-0912
Mailing Address - Fax:
Practice Address - Street 1:3406 GATESHEAD MANOR WAY
Practice Address - Street 2:202
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6112
Practice Address - Country:US
Practice Address - Phone:301-455-0912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist