Individual
ASHLEY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
846 OLD AIRPORT RD, BRISTOL, VA 24201-2244
(276) 701-5368
Mailing address
846 OLD AIRPORT RD, BRISTOL, VA 24201-2244
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001917
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0131001917
COTA/L
VA
Enumeration date
02/08/2019
Last updated
02/08/2019
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