Individual
JOEL CLARK I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
2003 COBB ST, FARMVILLE, VA 23901-2603
(434) 391-6061
Mailing address
2003 COBB ST, FARMVILLE, VA 23901-2603
(434) 391-6061
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000186
VA
Other
Enumeration date
12/17/2013
Last updated
12/17/2013
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