Individual
CHARLEY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9514 CONSOLE DR, SAN ANTONIO, TX 78229-2069
(210) 448-9111
Mailing address
9514 CONSOLE DR, SAN ANTONIO, TX 78229-2069
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216616
TX
Other
Enumeration date
03/16/2021
Last updated
03/16/2021
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