Provider Demographics
NPI:1871689802
Name:CLARK, PATRICIA PAULETTE (OCCUPATIONAL THERAPI)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:PAULETTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:PAULETTE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT OCCUPATIONAL THER
Mailing Address - Street 1:342 VIRGINIA AVENUE
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382
Mailing Address - Country:US
Mailing Address - Phone:276-228-6200
Mailing Address - Fax:276-228-9175
Practice Address - Street 1:342 VIRGINIA AVENUE
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA INC
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382
Practice Address - Country:US
Practice Address - Phone:276-228-6200
Practice Address - Fax:276-228-9175
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist