Individual
MRS. KAREN DANIELLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
5238 WEST CINNABAR AVENUE, GLENDALE, AZ 85302
(623) 518-2636
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
225800000X
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40919
NCTRC
—
Enumeration date
12/08/2010
Last updated
12/08/2010
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