Individual
ANDREA RENEE STARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8313 ASTA CT, BENBROOK, TX 76126-1671
(817) 907-7484
(817) 244-4652
Mailing address
8313 ASTA CT, BENBROOK, TX 76126-1671
(817) 907-7484
(817) 244-4652
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
108621
TX
Other
Enumeration date
06/15/2009
Last updated
06/15/2009
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