Individual
LONG CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,OTR/L
Contact information
Practice address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Mailing address
1708 W ROGERS AVE, BALTIMORE, MD 21209-4545
(410) 578-8600
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
04958
MD
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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