Individual
ANGELA NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
210 ORIOLE LN, TELFORD, TN 37690-2370
(423) 416-2242
Mailing address
210 ORIOLE LN, TELFORD, TN 37690-2370
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4328
TN
Other
Enumeration date
03/02/2015
Last updated
03/02/2015
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