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General NPI Number Information
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NPI Number | 1720612377
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Entity Type | Individual
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Provider Name | MEGHAN CLARK OTR/L
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Gender | Female
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Dates
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Enumeration Date | 02/22/2020
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Last Update Date | 02/22/2020
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Provider Practice Location Address
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Address Line | 2956 152ND AVE NE APT 360
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City | REDMOND
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State | WA
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Zip | 98052-5362
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Country | US
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Telephone | 425-298-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 8015 SE 58TH ST
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City | MERCER ISLAND
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State | WA
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Zip | 98040-4806
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 60940965
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License Number State | WA
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