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General NPI Number Information
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NPI Number | 1912752072
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Entity Type | Individual
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Provider Name | JOANN CLARK
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 2600 WAYLAND RD
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City | BERWYN
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State | PA
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Zip | 19312-2307
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Country | US
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Telephone | 610-325-4976
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Fax |
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Provider Business Mailing Address
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Address Line | 3302 ASHFIELD LN
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City | PHILADELPHIA
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State | PA
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Zip | 19114-1204
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Country | US
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Telephone | 215-681-8078
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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 | OC019421
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License Number State | PA
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