Individual
AMANDA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7146 BAHNE RD, FAIRVIEW, TN 37062
(615) 418-5498
Mailing address
7146 BAHNE RD, FAIRVIEW, TN 37062-8207
(615) 418-5498
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2598
TN
224Z00000X
Occupational Therapy Assistant
OTA.0001097
CO
224Z00000X
Occupational Therapy Assistant
OTA16750
FL
224Z00000X
Occupational Therapy Assistant
OTP-OTA-LIC-6114
MT
Other
Enumeration date
11/02/2016
Last updated
08/29/2018
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