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General NPI Number Information
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NPI Number | 1477128122
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Entity Type | Individual
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Provider Name | DEBRA P CLARK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 390 BROAD ST
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City | NASHUA
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State | NH
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Zip | 03063-3040
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Country | US
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Telephone | 603-566-8468
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HAPPY LN
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City | LONDONDERRY
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State | NH
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Zip | 03053-4042
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Country | US
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Telephone | 603-566-8468
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0393
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License Number State | NH
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