Individual
MRS. KELLY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
65 N SUSSEX ST, DOVER, NJ 07801-3949
(973) 361-5200
Mailing address
126 BROOKLYN RD, STANHOPE, NJ 07874-2966
(973) 691-0640
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09075500
NJ
Other
Enumeration date
09/13/2010
Last updated
09/13/2010
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