Individual
MS. BEVERLY ELAINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
10803 PAR LANE, WICHITA, KS 67212-5948
(316) 721-6997
Mailing address
10803 W PAR LN, WICHITA, KS 67212-5948
(316) 721-6997
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17-00289
KS
Other
Enumeration date
09/18/2012
Last updated
09/18/2012
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