Individual
MS. REBECCA-KELLY GRANT CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
3101 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3095
(503) 221-3429
(503) 294-3240
Mailing address
3101 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3095
(503) 221-3429
(503) 294-3240
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
275015
OR
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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