Individual
WANDA LOUISE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1422 SAN MARCO BLVD, JACKSONVILLE, FL 32207-8536
(904) 306-0177
Mailing address
1563 HARVEST COVE DR, MIDDLEBURG, FL 32068-6837
(904) 406-9239
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA4733
FL
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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