Individual
KELLY SUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6076 BRISTOL PKWY STE 105, LOS ANGELES, CA 90230-6600
(310) 642-7700
(310) 642-7700
Mailing address
6076 BRISTOL PKWY STE 105, LOS ANGELES, CA 90230-6600
(310) 642-7700
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12874
CA
Other
Enumeration date
01/08/2018
Last updated
01/08/2018
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