Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 1033 | TN |
NPI | 1013039031 |
---|---|
Provider Name | Ms. Diana Marie Clarke |
First Address | Rockvale, TN 37153-4078 |
Second Address | Murfreesboro, TN 37130-3931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |