Individual
MS. PATRICIA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
121 HOSPITAL DR, WATERTOWN, WI 53098-3303
(920) 261-9220
(920) 261-9208
Mailing address
W251 THOMPSON CIR, OCONOMOWOC, WI 53066-2012
(262) 567-4577
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2898-026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40796800
—
WI
Enumeration date
01/25/2007
Last updated
06/12/2012
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