Individual
MISS CHARISSA GRACE CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9200 GLENWATER DR, CHARLOTTE, NC 28262-8557
(704) 549-0807
Mailing address
9200 GLENWATER DR, CHARLOTTE, NC 28262-8557
(704) 549-0807
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
6584
NC
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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