Individual
SHELBY LEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
205 NOLAN PKWY, ARCHBOLD, OH 43502-8404
(419) 204-0833
Mailing address
534 CAROLYN DR, DELPHOS, OH 45833-1347
(419) 204-0833
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT010084
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT010084
OTPTAT BOARD
OH
Enumeration date
03/13/2018
Last updated
02/05/2020
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