Individual
CAMIEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1071 RENEE AVE, POCATELLO, ID 83201-2508
(208) 233-1411
Mailing address
1615 E CLARK ST, POCATELLO, ID 83201-4049
(907) 252-7295
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1635
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT-1635
AOTA
ID
Enumeration date
01/06/2017
Last updated
01/06/2017
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