Individual
LISA M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 SHORE DR, VIRGINIA BEACH, VA 23451-1199
(757) 496-1102
Mailing address
2649 SPRINGHAVEN DR, VIRGINIA BEACH, VA 23456-3995
(757) 472-0241
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002424
VA
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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