Individual
CHRISTINE RUTH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5000 MEMORIAL DR, TWO RIVERS, WI 54241-3900
(920) 794-5176
(920) 794-5472
Mailing address
2367 S 18TH ST, MANITOWOC, WI 54220-6453
(920) 626-1152
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1063-027
WI
Other
Enumeration date
02/22/2007
Last updated
07/08/2007
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