Individual
MRS. JILL PAGE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1500 WOODLINE DRIVE, RALEIGH, NC 27603-5760
(919) 773-0120
Mailing address
1500 WOODLINE DRIVE, RALEIGH, NC 27603-5760
(919) 773-0120
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4777
NC
Other
Enumeration date
12/04/2007
Last updated
12/04/2007
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