Individual
MELISSA NEWKAM CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
5745 OLD WINDER HWY STE C, BRASELTON, GA 30517-1637
(770) 965-1861
Mailing address
5745 OLD WINDER HWY STE C, BRASELTON, GA 30517-1637
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT005376
GA
Other
Enumeration date
11/10/2011
Last updated
11/10/2011
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