Provider Demographics
NPI:1376709394
Name:CLARK, ALISHIA MONIQUE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALISHIA
Middle Name:MONIQUE
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 LACKEY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HIDDENITE
Mailing Address - State:NC
Mailing Address - Zip Code:28636-7251
Mailing Address - Country:US
Mailing Address - Phone:704-402-0686
Mailing Address - Fax:
Practice Address - Street 1:792 LACKEY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HIDDENITE
Practice Address - State:NC
Practice Address - Zip Code:28636-7251
Practice Address - Country:US
Practice Address - Phone:828-635-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5559225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist