Individual
MRS. KRISTINE J. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.C.
Contact information
Practice address
VALLEY ORTHOPEDIC CLINIC SC, 2105 E ENTERPRISE AVE., STE 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Mailing address
VALLEY ORTHOPEDIC CLINIC SC, 2105 E ENTERPRISE AVE., STE 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-0813
ORTHOPAEDIC TECH-CERT
—
Enumeration date
11/27/2007
Last updated
11/27/2007
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