Individual
KENNETH EUGENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
4885 ELDON DR S, COLORADO SPRINGS, CO 80916-4431
(253) 486-3624
Mailing address
4885 ELDON DR S, COLORADO SPRINGS, CO 80916-4431
(253) 486-3624
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.0000671
CO
Other
Enumeration date
12/04/2015
Last updated
12/04/2015
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