Individual
MRS. JULIE DALLIA CLARK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1132 RUTHERFORD RD, GREENVILLE, SC 29609-3927
(864) 250-0005
(864) 250-0028
Mailing address
4 BERGAMOT CT, TAYLORS, SC 29687-4854
(864) 322-9290
(864) 250-0028
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
714
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH0980
—
SC
Enumeration date
12/07/2005
Last updated
07/09/2007
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