Provider Demographics
NPI:1154563161
Name:CLARK, VERONICA JEAN (MA OTR/L SLPTC)
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:JEAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:MA OTR/L SLPTC
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:JEAN
Other - Last Name:COVINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA OTR/L SIPTC
Mailing Address - Street 1:18350 MOUNT LANGLEY ST
Mailing Address - Street 2:#105
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6900
Mailing Address - Country:US
Mailing Address - Phone:714-965-2324
Mailing Address - Fax:714-965-2684
Practice Address - Street 1:18350 MOUNT LANGLEY ST
Practice Address - Street 2:#105
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6900
Practice Address - Country:US
Practice Address - Phone:714-965-2324
Practice Address - Fax:714-965-2684
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9648225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics