Individual
KATIE LYNNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2012 S JONES BLVD, LAS VEGAS, NV 89146-3151
(702) 360-1137
Mailing address
283 DEERLEAP CIR, HENDERSON, NV 89052-2340
(702) 285-3153
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2032
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164760369
—
NV
Enumeration date
01/22/2013
Last updated
12/09/2018
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