Provider Demographics
NPI:1831274398
Name:CLARK, JOANNE MARY (OTR)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARY
Last Name:CLARK
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11889 TARRYNOT LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9693
Mailing Address - Country:US
Mailing Address - Phone:317-504-6628
Mailing Address - Fax:317-571-8125
Practice Address - Street 1:11889 TARRYNOT LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9693
Practice Address - Country:US
Practice Address - Phone:317-504-6628
Practice Address - Fax:317-571-8125
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002417A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist