Provider Demographics
NPI:1427665694
Name:CLARK, PATRICIA JANE (OT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JANE
Last Name:CLARK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STRAWBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5941
Mailing Address - Country:US
Mailing Address - Phone:207-330-9325
Mailing Address - Fax:
Practice Address - Street 1:PATRICIA CLARK
Practice Address - Street 2:408 CENTER BRIDGE ROAD
Practice Address - City:TURNER
Practice Address - State:ME
Practice Address - Zip Code:04282
Practice Address - Country:US
Practice Address - Phone:207-754-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME048225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist