Individual
MRS. LEITA FAYE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1008 THOMPSON ST, JERSEY SHORE, PA 17740-1729
(570) 398-4747
Mailing address
293 CHESTNUT RIDGE RD, JERSEY SHORE, PA 17740-8930
(570) 321-6621
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP000930L
PA
Other
Enumeration date
10/23/2008
Last updated
10/23/2008
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