Individual
MARY MARTHA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
2495 MAPLEWOOD DRIVE, SUITE 313, MAPLEWOOD, MN 55109-1913
(651) 770-8884
(651) 770-8151
Mailing address
616 PARK ST, ANOKA, MN 55303-1932
(763) 323-1336
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
100082
MN
Other
Enumeration date
02/20/2007
Last updated
03/25/2009
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