Individual
EMILY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
110 MORDINGTON AVE, CHARLES TOWN, WV 25414-1693
(304) 267-3595
(304) 267-3599
Mailing address
110 MORDINGTON AVE, CHARLES TOWN, WV 25414-1693
(304) 267-3595
(304) 267-3599
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1889
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1889
WV BOARD OF OCCUPATIONAL THERAPY
WV
Enumeration date
10/09/2017
Last updated
06/16/2018
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