Individual
BRENDA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1011 PORTERS NECK RD, WILMINGTON, NC 28411-9196
(910) 686-7195
Mailing address
204 WHISPERING PINES CT, HAMPSTEAD, NC 28443-3429
(910) 270-8549
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4066
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4066
OT LICENSURE
NC
Enumeration date
03/27/2007
Last updated
07/08/2007
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