Individual
MICHELLE ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
457 C DEES RD, DERIDDER, LA 70634-8935
(404) 433-1208
Mailing address
457 C DEES RD, DERIDDER, LA 70634-8935
(404) 433-1208
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.Z11886
LA
Other
Enumeration date
02/09/2009
Last updated
02/09/2009
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