Individual
MRS. MAUREEN CHARBENEAU CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
241 KIOWA DR, MADISON, MS 39110-8813
(601) 291-5852
Mailing address
241 KIOWA DR, MADISON, MS 39110-8813
(601) 291-5852
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1722
MS
Other
Enumeration date
12/20/2008
Last updated
12/20/2008
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