Individual
KIMBERLY L CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
28 CARSON DR, GORHAM, ME 04038-2189
(207) 839-7117
Mailing address
28 CARSON DR, GORHAM, ME 04038-2189
(207) 839-7117
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT521
ME
Other
Enumeration date
05/23/2005
Last updated
07/09/2007
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