Individual
ASIA RENEE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
8552 S BENNETT AVE APT 3, CHICAGO, IL 60617-2364
(773) 656-3312
Mailing address
8552 S BENNETT AVE APT 3, CHICAGO, IL 60617-2364
(773) 656-3312
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
057.005571
IL
225X00000X
Occupational Therapist
Primary
056.015612
IL
Other
Enumeration date
10/04/2021
Last updated
08/14/2023
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