Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 3421 | TN |
N | 225XP0200X | Occupational Therapist - Pediatrics | 3421 | TN |
NPI | 1053343681 |
---|---|
Provider Name | Carol Shelby Clark |
First Address | Franklin, TN 37064-5566 |
Second Address | Brentwood, TN 37027-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 28/04/2009 |