Organization
OUTPATIENT MOBILE
Active
Other names
Outpatient Mobile
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA LEE CLARK OTD OTR/L (OCCUPATIONAL THERAPIST)
(607) 643-2178
Entity
Organization
Contact information
Practice address
113 LABBY RD, NORTH GROSVENORDALE, CT 06255-1247
(607) 643-2178
Mailing address
113 LABBY RD, NORTH GROSVENORDALE, CT 06255-1247
(607) 643-2178
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
01/09/2019
Last updated
01/09/2019
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