Individual
MARGO CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 412-5135
Mailing address
1041 STEEPLE VIEW DR, EAGLE, ID 83616-4721
(208) 412-5135
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-034
ID
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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