Individual
MRS. DENISE MICHELLE CLARK
Active
Individual
MRS. DENISE MICHELLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR CHT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT00001716
WA
225XH1200X
Hand Occupational Therapist
Primary
9711000164
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126095
L & I
WA
01
—
7466CL
REGENCE
WA
05
—
7680697
—
WA
Enumeration date
03/07/2007
Last updated
10/18/2011
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