Individual
KATHLEEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
221 LYNNHAVEN DR, NORTH SYRACUSE, NY 13212-2025
(315) 256-2726
Mailing address
221 LYNNHAVEN DR, NORTH SYRACUSE, NY 13212-2025
(315) 256-2726
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001774-1
NY
Other
Enumeration date
01/15/2016
Last updated
01/15/2016
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