Individual
LORI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4487 TRAIL ST, NORCO, CA 92860-2487
(951) 415-3440
Mailing address
4487 TRAIL ST, NORCO, CA 92860-2487
(951) 415-3440
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTA 408
CA
Other
Enumeration date
03/04/2016
Last updated
03/04/2016
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