Individual
CLARK UPTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
302 N 2ND ST, BRIDGEWATER, VA 22812-1712
(540) 828-3738
Mailing address
302 N 2ND ST, BRIDGEWATER, VA 22812-1712
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131000288
VA
Other
Enumeration date
10/23/2012
Last updated
10/31/2012
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