Individual
KERRY A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1464
NH
225X00000X
Occupational Therapist
OT2247
ME
225X00000X
Occupational Therapist
Primary
PHYO2872
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHYO2872
OT LICENSE
AK
Enumeration date
05/02/2011
Last updated
05/01/2019
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